The importance of accounting for patients' age when choosing radiation endovascular technologies as the main treatment for acute gastroduodenal ulcer bleeding

Treatment of patients with acute ulcerative gastroduodenal bleeding is associated with certain difficulties. The introduction of X-ray endovascular occlusion of abdominal vessels in this life-threatening condition contributes to improving the quality of medical care, its effectiveness and safety. However, there is still no consensus among experts on the effectiveness of using this technology in the process of eliminating ulcerative bleeding in people of different ages. Objective: to evaluate the possibilities of using X-ray endovascular occlusion of abdominal vessels in the elimination of acute ulcerative gastroduodenal bleeding, taking into account the age characteristics of the patient's body. The effectiveness of eliminating acute gastroduodenal ulcerative bleeding in 2 557 patients from two large clinics in St. Petersburg was studied. The data analysis was carried out taking into account the age of the patients and the use of X-ray endovascular occlusion of the abdominal vessels in the therapeutic and diagnostic process. This technology was used in 194 cases in patients of the Alexander City Hospital (their age did not exceed 90 years), and in the treatment of 31 centenarians (patients aged 90+ years), specialists of the St. Petersburg Hospital for War Veterans reasonably refrained from this surgical technique. The efficiency index of endovascular interventions during the elimination of hemorrhages of ulcerative origin was 91.4 %, the total mortality parameter did not exceed 4.1 %. The initial endoscopic assessment of gastroduodenal ulcers complicated by bleeding in centenarians revealed a state of stable hemostasis in most cases (24 out of 31). In seven cases of centenarians with signs of hemostasis instability, a recurrence of bleeding from ulcers occurred in one (14.3 %) patient (re-eliminated without surgery). The desire to stop bleeding from gastric and duodenal ulcers in the process of providing medical care to patients of older age groups through purely minimally invasive methods (even based on the apparent impression of low-traumatic endovascular effects) should not prevail over the sense of special responsibility of specialists for the fate of centenarians due to their high risk of using any surgical technologies to achieve stable hemostasis.

1. Tantsev AO, Korolkov AYu, Popov DN, et al. Retrospective multicenter analysis of treatment results for chronic duodenal ulcers complicated by bleeding. Scientific Notes of the First St. Petersburg State Medical University named after Academician IP Pavlov. 2024;31(3):58–65. (In Russ.).

2. Revishvili ASh, Olovyannyy VE, Sazhin VP, et al. Surgical care in the Russian Federation: information and analytical collection for 2021. Moscow: NMIC Surgery named after AV Vishnevsky, 2022, 200. (In Russ.).

3. Ivashkin VT, Maev IV, Tsarkov PV, et al. Diagnosis and treatment of peptic ulcer disease in adults (Clinical guidelines of the Russian Gastroenterological Association, Russian Society of Colorectal Surgeons, Russian Endoscopic Society and Scientific Community for Promoting Clinical Study of the Human Microbiome). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2024;34(2):101–131. (In Russ.).

4. Yablonskiy PK, Skryabin ON. Analysis of emergency surgical care for patients with "acute abdomen" in St. Petersburg for 2016, taking into account the results of the City Clinical Expert Commission. Actual Issues of Surgery: Minimally Invasive Technologies – The Future of Surgery: Proceedings. St. Petersburg, 2017, 6 p. (In Russ.).

5. Mille M, Engelhardt T, Stier A. Bleeding duodenal ulcer: strategies in high-risk ulcers. Visc Med. 2021;37(1):52–62. https://doi.org/10.1159/000513689.

6. Bedin VV, Korzheva IYu, Tsurkan VA, et al. Preventive radiological endovascular arterial embolization in patients with ulcerative gastroduodenal bleeding at high risk of recurrence. Moscow Surgical Journal. 2023;(1):50–56. (In Russ.).

7. Pirogov Surgical Society. Protocol of the 2553rd meeting [Internet]. 2022 Apr 13 [cited 2025 Nov 01]. Available from: https://pirogovssociety.tilda.ws/page30696893.html.

8. Akimov VP, Levin LA, Kubachev KG, et al. Acute surgical diseases of the abdominal cavity organs. Ed. by VP Akimov. 2nd ed., revised and supplemented. St. Petersburg, 2021, 256 p. (In Russ.).

9. Andrusenko AV, Vavilova OG, Glushkov NI, et al. Surgical gastroenterology in patients of elderly and senile age. Ed. by MYu Kabanov, NI Glushkov, AL Levchuk. Moscow: DPK Press, 2021. 448 p. (In Russ.).

10. Lau JYW, Pittayanon R, Wong KT, et al. Combination therapy versus monotherapy in the endoscopic treatment of high-risk bleeding ulcers: A meta-analysis of controlled trials. Gastrointest Endosc. 2021;93(5):989–998. https://doi.org/10.1016/j.gie.2020.09.047.

11. Lau JYW, Pittayanon R, Wong KT, et al. Prophylactic angiographic embolisation after endoscopic control of bleeding to high-risk peptic ulcers: a randomised controlled trial. Gut. 2019;68(5):796–803. https://doi.org/10.1136/gutjnl-2018-316074.

12. Kaminskis A, Ivanova P, Kratovska A, et al. Endoscopic hemostasis followed by preventive transarterial embolization in high-risk patients with bleeding peptic ulcer: 5-year experience. World J Emerg Surg. 2019;10(14):45.

13. Stanley AJ, Laine L, Dalton HR, et al; International Gastrointestinal Bleeding Consortium. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. https://doi.org/10.1136/bmj.i6432.

14. Lanas A, Dumonceau JM, Hunt RH, et al. Age-related differences in peptic ulcer bleeding outcomes: A systematic review and meta-analysis. Gastroenterology. 2022;163(2):512–525. https://doi.org/10.1053/j.gastro.2022.04.034.

15. Laursen SB, Hansen JM, Andersen PE, et al. Supplementary arterial embolization an option in high-risk ulcer bleeding: a randomized study. Scand J Gastroenterol. 2014;49(1):75–83. https://doi.org/10.3109/00365521.2013.865782.

16. Smith RL, Patel AA, Lee JK. Transcatheter embolization with microspheres for refractory peptic ulcer bleeding: A multicenter cohort study. J Vasc Interv Radiol. 2020;31(5):712–720. https://doi.org/10.1016/j.jvir.2019.12.805.

17. Musinov IM, Chikin AE, Sandursky GV, et al. Radiological endovascular embolization in the treatment of ulcerative gastroduodenal bleeding. Emergency Medical Care. 2023;24(1):55–59. (In Russ.).

18. Kuzin MI. Surgical Diseases. Moscow: Medicina, 1980. 496 p. (In Russ.).

19. Yudin SS. Essays on Gastric Surgery. Moscow: Medgiz, 1955, 264 p. (In Russ.).

20. Russian Society of Surgeons. Ulcerative gastroduodenal bleeding: clinical guidelines [Internet]. Voronezh; 2014 [cited 2025 Nov 01]. Available from https://www.mrckb.ru/files/yazvennye_gastroduodenalnye_krovotecheniya.PDF. (In Russ.).