Evaluation of The Choice of Hemostasis Methods in Patients With a High Risk of Recurrent Gastroduodenal Bleeding

AIM OF THE STUDY Evaluation of the results of prophylactic transarterial embolization after primary endoscopic hemostasis among patients with a high risk of rebleeding.

MATERIAL AND METHODS This is a prospective study. In the period from 2019 to 2023, a total of 118 patients with acute gastroduodenal bleeding (AGDB), classified as Forrest type IA , IB and IIA on the Rockall scale of at least 5, sought medical assistance. Among them 87 (73.7%) were men and 31 (26.3%), were women (p<0.01). The age of the patients ranged from 21 to 81 years, while the average age was 49.8±18.5 years.

RESULTS Of the 118 patients with AGDB, 45 (38.1%) had a high risk of rebleeding after endoscopic hemostasis. Of this group, 28 patients (23.7%) underwent preventive transarterial embolization and 90 patients (76.3%) underwent endoscopic hemostasis. A significantly lower rebleeding rate was observed in the preventive transarterial group embolization (3.6% versus 13.3%) — in the endoscopic hemostasis group (p=0.005). The need for surgical intervention reached 3.6% versus 4.4% in the preventive transarterial embolization and endoscopic hemostasis, respectively (p=0.068). Patients who underwent preventive transarterial embolization, required less fresh frozen plasma, 1.3 units versus 2.6 units with endoscopic hemostasis (p=0.001). The mortality rate was similar in the groups with a tendency to decrease in the preventive transarterial embolization: 3.6% versus 4.4% endoscopic hemostasis (p=0.418).

CONCLUSION Prophylactic transarterial embolization is a feasible and safe procedure that may help reduce the incidence of rebleeding and the need for surgical intervention in patients with acute gastroduodenal bleeding when the risk of rebleeding remains high after primary endoscopic hemostasis.

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