Transcatheter and Endoscopic Treatment of Gastric and Duodenal Bleeding: Population-Based Analysis of National Inpatient Trends and Outcomes in the United States

Background: Upper gastrointestinal (GI) bleeding is a common cause of hospital admission in the United States and is frequently treated by endoscopy. Recent studies have shown an increasing role for treatment using transcatheter embolization. Methods: Data from the national inpatient sample (1993-2015) were used for trend analysis and to compare patient characteristics, comorbidities, and outcomes for endoscopic and transcatheter treatments of gastric and duodenal bleeding. Results: Despite the continued decline in the rate of hospitalization for upper GI bleeding (−43% since 1993, P < .01), admissions for embolization (21.1% per year since 2005, P < .01) and endoscopic treatments (1.2%-6.1% per year since 1993, P < .01) have increased in the past decade. Patients with multiple comorbidities that include coagulopathy (25.6% versus 11.9%, P < .05), liver disease (16.0% versus 10.7%, P < .05), fluid and electrolyte disorder (51.0% versus 35.4%, P < .05), and metastatic cancer (6.9% versus 2.4%, P < .05) were more likely to receive embolization. Embolization was associated with higher crude risk of death (9.2% versus 2.1%, P < .01), lengthier hospital stays (9.1 days versus 5.1 days, P < .01), and greater average total hospital charges (US$135,000 versus US$46,000). The association between embolization (versus endoscopy) and mortality and length of stay diminished after controlling for disease severity and other procedures in propensity score-matched groups and by covariate adjustment. Discussion: Though endoscopy remains the main treatment of upper GI bleeding, embolization is associated with comparable mortality and length of stay after accounting for disease severity and the need for additional procedures.