Letters To The Editor
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World J Gastroenterol. Feb 21, 2013; 19(7): 1150-1151
Published online Feb 21, 2013. doi: 10.3748/wjg.v19.i7.1150
Management of duodenal ulcer bleeding resistant to endoscopy: Surgery is dead!
Romaric Loffroy
Romaric Loffroy, Cardiovascular Imaging Unit, Department of Vascular and Interventional Radiology, Bocage Teaching Hospital, University of Dijon School of Medicine, 21079 Dijon Cedex, France
Author contributions: Loffroy R wrote this letter.
Correspondence to: Romaric Loffroy, MD, PhD, Cardiovascular Imaging Unit, Department of Vascular and Interventional Radiology, Bocage Teaching Hospital, University of Dijon School of Medicine, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon Cedex, France. romaric.loffroy@chu-dijon.fr
Telephone: +33-380-293677 Fax: +33-380-293455
Received: November 23, 2012
Revised: December 17, 2012
Accepted: January 17, 2013
Published online: February 21, 2013
Processing time: 90 Days and 12.8 Hours
Abstract

Acute massive duodenal bleeding is one of the most frequent complications of peptic ulcer disease. Endoscopy is the first-line method for diagnosing and treating actively bleeding peptic ulcers because its success rate is high. Of the small group of patients whose bleeding fails to respond to endoscopic therapy, increasingly the majority is referred for embolotherapy. Indeed, advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the management of hemorrhage from peptic ulcers over the past decade. Embolization may be effective for even the most gravely ill patients for whom surgery is not a viable option, even when extravasation is not visualized by angiography. However, it seems that careful selection of the embolic agents according to the bleeding vessel may play a role in a successful outcome. The role of the surgeon in this clinical sphere is dramatically diminishing and will certainly continue to diminish in ensuing years, surgery being typically reserved for patients whose bleeding failed to respond all previous treatments. Such a setting has become extremely rare.

Keywords: Massive hemorrhage; Duodenal ulcer; Angiography; Transcatheter embolization; Surgery