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首页> 外文期刊>European journal of gastroenterology and hepatology >Management of nonvariceal upper gastrointestinal bleeding resistant to endocopic hemostasis: Will transcatheter embolization replace surgery?
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Management of nonvariceal upper gastrointestinal bleeding resistant to endocopic hemostasis: Will transcatheter embolization replace surgery?

机译：耐内窥镜止血的非静脉曲张性上消化道出血的处理：经导管栓塞术可替代手术吗？

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摘要

We read with great interest the article written by Ang et al. [1], comparing surgery with transcatheter angio-graphic embolization (TAE) in the treatment of non-variceal upper gastrointestinal bleeding (NVUGIB) uncontrolled by endoscopy. We have several comments. The higher rebleeding rate after TAE could be one of the reasons why there was no difference in the mortality rate between the embolotherapy and the surgical treatment groups in this report, as well as in two other retrospective studies that compared TAE and surgery [2,3]. The fact that the mortality rate was similar and the rebleeding rate was higher after TAE, raises the question of whether we should offer TAE as an alternative to surgery in low-risk surgical candidates. Only a future randomized-controlled trial can answer this question. However, there are several logistical problems involved in such a study. One main concern is the possibility of selection bias. It is unlikely that an endoscopist/surgeon who has diagnosed severe bleeding from the gastroduodenal artery in an unstable patient would transfer that patient to a radiology suite if randomization resulted in TAE. To be able to carry out a true randomized study, the involved centers must be equipped with an operating theater with both angio-graphic and surgical facilities.
机译：我们非常感兴趣地阅读了Ang等人撰写的文章。 [1]，将手术与经导管血管造影术栓塞术（TAE）在内窥镜检查无法控制的非静脉曲张上消化道出血（NVUGIB）的治疗中进行比较。我们有几条评论。 TAE后更高的再出血率可能是该报告以及其他两项比较TAE和手术的回顾性研究中栓塞治疗组和手术治疗组死亡率没有差异的原因之一[2,3 ]。 TAE后死亡率相似且再出血率更高这一事实提出了一个问题，即在低风险的手术对象中我们是否应提供TAE作为手术的替代方法。只有未来的随机对照试验才能回答这个问题。但是，这项研究涉及几个后勤问题。一个主要问题是选择偏向的可能性。如果随机分配导致TAE，则内镜医师/外科医生在不稳定的患者中诊断出胃十二指肠动脉严重出血的可能性不大可能将该患者转移至放射科。为了能够进行真正的随机研究，所涉及的中心必须配备手术室，并配备血管造影和外科手术设施。

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