Nonvariceal upper gastrointestinal bleeding refractory to endoscopy: The role of interventional radiology and surgery

Acute nonvariceal upper gastrointestinal bleeding is a common and life-threatening emergency. Despite optimal endoscopic and pharmacologic therapy, 8%-10% of patients continue to bleed or develop rebleeding. Surgery has been the traditional salvage treatment in these patients. However, surgery is associated with high morbidity and mortality rates. In the past few decades, transarterial embolization has emerged as a promising nonoperative alternative to surgery. High technical (69%-100%) and clinical success rate (63%-97%) were reported. However, comparative studies between the 2 treatment modalities are retrospective in nature. Current guidelines suggest transarterial embolization to be an alternative to surgery if expertise is available. This review attempts to summarize the published literature and to provide our view on the role of radiology and surgery for acute nonvariceal upper gastrointestinal bleeding refractory to endoscopic treatment. Factors leading to rebleeding and preventive measures to improve outcomes are also discussed.