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Abstract：
BACKGROUND: To investigate factors associated with risk for rebleeding and 30-day mortality following prophylactic transarterial embolization in patients with high-risk peptic ulcer bleeding.
METHODS: We retrospectively reviewed medical records and included all patients who had undergone prophylactic embolization of the gastroduodenal artery at Rigshospitalet, Denmark, following an endoscopy-verified and treated peptic Sulcer bleeding, from 2016 to 2021. Data were collected from electronic health records and imaging from the embolization procedures. Primary outcomes were rebleeding and 30-day mortality. We performed logistical regression analyses for both outcomes with possible risk factors. Risk factors included: active bleeding; visible hemoclips; Rockall-score; anatomical variants; standardized embolization procedure; and number of endoscopies prior to embolization.
RESULTS: We included 176 patients. Rebleeding occurred in 25% following embolization and 30-day mortality was 15%. Not undergoing a standardized embolization procedure increased the odds of both rebleeding (odds ratio 3.029, 95% confidence interval (CI) 1.395-6.579) and 30-day overall mortality by 3.262 (1.252-8.497). More than one endoscopy was associated with increased odds of rebleeding (odds ratio 2.369, 95% CI 1.088-5.158). High Rockall-score increased the odds of 30-day mortality (odds ratio 2.587, 95% CI 1.243-5.386). Active bleeding, visible hemoclips, and anatomical variants did not affect risk of rebleeding or 30-day mortality. Reasons for deviation from standard embolization procedure were anatomical variations, targeted treatment without embolizing the gastroduodenal artery, and technical failure.
CONCLUSIONS: Deviation from the standard embolization procedure increased the risk of rebleeding and 30-day mortality, more than one endoscopy prior to embolization was associated with higher odds of rebleeding, and a high Rockall-score increased the risk of 30-day mortality. We suggest that patients with these risk factors are monitored closely following embolization. Early detection of rebleeding may allow for proper and early re-intervention.
METHODS: We retrospectively reviewed medical records and included all patients who had undergone prophylactic embolization of the gastroduodenal artery at Rigshospitalet, Denmark, following an endoscopy-verified and treated peptic Sulcer bleeding, from 2016 to 2021. Data were collected from electronic health records and imaging from the embolization procedures. Primary outcomes were rebleeding and 30-day mortality. We performed logistical regression analyses for both outcomes with possible risk factors. Risk factors included: active bleeding; visible hemoclips; Rockall-score; anatomical variants; standardized embolization procedure; and number of endoscopies prior to embolization.
RESULTS: We included 176 patients. Rebleeding occurred in 25% following embolization and 30-day mortality was 15%. Not undergoing a standardized embolization procedure increased the odds of both rebleeding (odds ratio 3.029, 95% confidence interval (CI) 1.395-6.579) and 30-day overall mortality by 3.262 (1.252-8.497). More than one endoscopy was associated with increased odds of rebleeding (odds ratio 2.369, 95% CI 1.088-5.158). High Rockall-score increased the odds of 30-day mortality (odds ratio 2.587, 95% CI 1.243-5.386). Active bleeding, visible hemoclips, and anatomical variants did not affect risk of rebleeding or 30-day mortality. Reasons for deviation from standard embolization procedure were anatomical variations, targeted treatment without embolizing the gastroduodenal artery, and technical failure.
CONCLUSIONS: Deviation from the standard embolization procedure increased the risk of rebleeding and 30-day mortality, more than one endoscopy prior to embolization was associated with higher odds of rebleeding, and a high Rockall-score increased the risk of 30-day mortality. We suggest that patients with these risk factors are monitored closely following embolization. Early detection of rebleeding may allow for proper and early re-intervention.
摘要：
背景：探讨高危消化性溃疡出血患者预防性经动脉栓塞术后再出血风险和30天死亡率的相关因素。
方法：我们回顾性回顾了医疗记录，包括所有在Rigshospitalet进行了胃十二指肠动脉预防性栓塞的患者，丹麦,在内窥镜检查证实和治疗的消化性硫化物出血后，从2016年到2021年。数据是从电子健康记录和栓塞程序的成像中收集的。主要结果是再出血和30天死亡率。我们对两种可能的危险因素的结果进行了后勤回归分析。危险因素包括：活动性出血；可见的血唇；Rockall评分；解剖学变异；标准化栓塞程序；以及栓塞前的内窥镜检查次数。
结果：我们纳入了176例患者。栓塞后再出血发生率为25％，30天死亡率为15％。未进行标准化栓塞手术的再出血几率（比值比3.029，95％置信区间（CI）1.395-6.579）和30天总死亡率增加了3.262（1.252-8.497）。一次以上的内窥镜检查与再出血几率增加相关（比值比2.369，95％CI1.088-5.158）。高Rockall评分增加了30天死亡率的几率(比值比2.587,95%CI1.243-5.386)。活动性出血,可见的hemoclips,解剖变异不影响再出血风险或30日死亡率.偏离标准栓塞程序的原因是解剖变异，不栓塞胃十二指肠动脉的靶向治疗，技术故障。
结论：偏离标准栓塞程序会增加再出血和30天死亡率的风险，栓塞前一次以上的内镜检查与更高的再出血几率相关,高Rockall评分会增加30天死亡率的风险.我们建议在栓塞后密切监测具有这些危险因素的患者。早期发现再出血可以允许适当和早期的再干预。
方法：我们回顾性回顾了医疗记录，包括所有在Rigshospitalet进行了胃十二指肠动脉预防性栓塞的患者，丹麦,在内窥镜检查证实和治疗的消化性硫化物出血后，从2016年到2021年。数据是从电子健康记录和栓塞程序的成像中收集的。主要结果是再出血和30天死亡率。我们对两种可能的危险因素的结果进行了后勤回归分析。危险因素包括：活动性出血；可见的血唇；Rockall评分；解剖学变异；标准化栓塞程序；以及栓塞前的内窥镜检查次数。
结果：我们纳入了176例患者。栓塞后再出血发生率为25％，30天死亡率为15％。未进行标准化栓塞手术的再出血几率（比值比3.029，95％置信区间（CI）1.395-6.579）和30天总死亡率增加了3.262（1.252-8.497）。一次以上的内窥镜检查与再出血几率增加相关（比值比2.369，95％CI1.088-5.158）。高Rockall评分增加了30天死亡率的几率(比值比2.587,95%CI1.243-5.386)。活动性出血,可见的hemoclips,解剖变异不影响再出血风险或30日死亡率.偏离标准栓塞程序的原因是解剖变异，不栓塞胃十二指肠动脉的靶向治疗，技术故障。
结论：偏离标准栓塞程序会增加再出血和30天死亡率的风险，栓塞前一次以上的内镜检查与更高的再出血几率相关,高Rockall评分会增加30天死亡率的风险.我们建议在栓塞后密切监测具有这些危险因素的患者。早期发现再出血可以允许适当和早期的再干预。
