Endoscopic Clips Marking for Transcatheter Arterial Embolization in Refractory Peptic Ulcer Bleeding Patients: A Cohort Study

Background and Aims: Transcatheter arterial embolization (TAE) is recommended for refractory peptic ulcer bleeding. There are 46% of patients showed no detectable contrast extravasation during TAE. Endoscopic clip in bleeding lesion is visible and could be used as a marker in TAE. We aimed to learn whether endoscopic clips marking would ameliorate the prognosis. Methods: We retrospectively collected data of patents who received TAE because of refractory peptic ulcer bleeding, between 1 January 2016 to 31 December 2022. 188 patients were included and divided into two groups according to clips visibility in angiography. Baseline data about age, gender, bleeding severity, comorbidities, history of antiplatelet or anticoagulation drugs and endoscopic findings were balanced with the inverse probability of treatment weighting method. Results: There were 59 patients without clips received TAE, and 129 with clips. The in-hospital rebleeding rate after TAE was much higher in patients without clip than with clips (45.8% vs 33.3%). Cox regression analysis indicated that endoscopic clips marking decreased the rebleeding (aHR=0.492, 95%CI: 0.242-1.001, p=0.050). Also, in patient with clips, the empirical TAE rate was higher (64.3% vs 11.9%, p<0.001). No difference in in-hospital all-cause mortality was found (without clips vs with clips 11.9% vs 12.4%). The hospital stay length and embolized vessels types showed no differences between the two groups. Conclusions: In refractory peptic ulcer bleeding patients, endoscopic clips marking decreased the in-hospital rebleeding rate after TAE, but did not affect the mortality.