Endovascular embolization haemostasis in patients with non variceal upper gastrointestinal haemorrhage.

INTRODUCTION. The guidelines of the non variceal upper gastrointestinal haemorrhage (NVUGIH) have been changed several times in the last
decade. An important role in modern medicine is played by angiography
and endovascular embolization haemostasis. The aim of this study is to
clarify the efficacy of endovascular treatment of NVUGIH and to report
the first experience with this method at a university hospital.
MATHERIAL AND METHODS. In total 500 patients with NVUGIH between
November 2010 and January 2015 were treated in Riga East Clinical University Hospital. Peptic ulcer disease, Mallory – Weiss syndrome, Dieulafoy's
lesion, gastrointestinal oncologic diseases and erosive gastritis were the
main sources of bleeding. In subsequent data analysis were included patients
with peptic ulcer disease (n = 379) Forrest classification 1A-2C. Patients
with high risk of repeated bleeding who underwent endovascular embolization haemostasis (EEH) were included in the EEH group and patients who
underwent surgical treatment were included in the ST group.
RESULTS. Endoscopic haemostasis was successful in 207 cases (54.8%).
Surgical intervention and haemostasis were performed in 77 patients
(20.3%). Altogether 62.4% of the operated patients underwent surgical
haemostasis after failed endoscopic haemostasis and, 37.6 % of the operated patients underwent surgery because of high risk of repeated bleeding.
In total rebleeding occurred in 53 patients at a median of two days (IQR =
3–1) after the first attempt of haemostasis.
The EEH group consisted of 11 patients (81.8% male patients with median
age 65 years (88–48)) and the ST group consisted of 28 patients (57.1% male
patients with median age 61 years (73–55)).
Ulcer size and frequency of comorbid conditions were not different for
the groups, median number of transfused packed red blood cell units was
significantly lower in the EEH group compared to the ST group, median of
3 (IQR 5–2) units vs. 5 (IQR 7–3) units, respectively, p = 0.046. Total hospital
stay was shorter in the EEH group, median of 6 (IQR 9–6) days vs. 12 (IQR
18–9) days in the ST group, p = 0.001, however ICU stay was not different
for the groups. Mortality in the EEH group was 9.1% (one deceased patient)
and 7.1% in the ST group (two deceased patients), p = 1.000.
CONCLUSION. Preventive endovascular embolisation haemostasis is a
reasonable alternative to surgical haemostasis in patients with high risk
of rebleeding.