The use of prophylactic transcatheter arterial embolization in Forrest type II ulcer patients without attempted endoscopic hemostasis

This study aims to report the utility of prophylactic transcatheter arterial embolization (TAE) in Forrest type II ulcer patients without attempted endoscopic hemostasis and evaluate the factors associated with positive angiography. Forrest type II ulcer patients without attempted endoscopic hemostasis underwent prophylactic TAE between September 2019 and July 2023 at a single academic medical center were retrospectively reviewed. Patient demographics, clinical presentations, comorbidities, medications, endoscopy findings, laboratory investigations, the time intervals between endoscopy and TAE, interventional procedure findings, the occurrences of rebleeding, complications and clinical outcomes were recorded. The outcome measures were technical and clinical success, procedure related complications, recurrent bleeding and 30-day mortality. The factors associated with positive angiography were also assessed with univariate analysis and multivariate analysis. 12 patients (36.4%) had gastric ulcers and 21 (63.6%) had duodenal ulcers. 22 patients (66.7%) presented with Forrest IIa ulcers and 11 (33.3%) presented with Forrest IIb ulcers. Technical success rate was 100% without TAE related complication. Clinical success rate was 97.0% and rebleeding rate was 3.0%. 15 patients (45.5%) had positive angiography. Of them, 9 had contrast extravasation and 6 had pseudoaneurysms. Univariate analysis of the factors associated with positive angiography showed differences in sex (93.3% vs 61.1%, respectively, P = .046) and history of NSAIDs (73.3% vs 22.2%, respectively, P = .005). Multivariate analysis associated with positive angiography showed differences in history of NSAIDs (OR = 8.76, 95 CI = 1.61-47.62, P = .012). Prophylactic TAE is a safe, and effective method for treating Forrest type II ulcer patients without attempted endoscopic hemostasis.