Issue: 2013 > September > review

An upper gastrointestinal ulcer still bleeding after endoscopy: what comes next?

E.M.E. Craenen, H.S. Hofker, F.T.M. Peters, G.M. Kater, K.R. Glatman, J.G. Zijlstra


Introduction: Recurrent bleeding from an upper gastrointestinal ulcer when endoscopy fails is a reason for
radiological or surgical treatment, both of which have their
advantages and disadvantages. Case: Based on a patient with recurrent gastrointestinal bleeding, we reviewed the available evidence regarding the efficacy and safety of surgical treatment and embolisation, respectively.
Discussion: Transarterial embolisation (TAE) and surgical
treatment are both options for recurrent gastrointestinal
bleeding when endoscopy fails. Both therapies have serious complications and a risk of rebleeding. Choosing the therapy depends on the capability of the patient to tolerate haemodynamic instability, resuscitation and hypotension. Conclusion: Choosing between TAE and surgery depends a great deal on the case presented, haemodynamic stability and the skills and tools available at that moment.