Prophylactic Transcatheter Arterial Embolization Reduces Rebleeding in Non-variceal Upper Gastrointestinal Bleeding: A Meta-analysis

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2021 Nov 18

PMID 34790019

Citations 2

Authors

Eszter Boros

Zoltan Sipos

Peter Hegyi

Brigitta Teutsch

Levente Frim

Szilard Vancsa

Szabolcs Kiss

Fanni Dembrovszky

Eduard Ostarijas

Andrew Shawyer

Balint Eross

Affiliations

Soon will be listed here.

Abstract

Background: Despite the improvement in the endoscopic hemostasis of non-variceal upper gastrointestinal bleeding (NVUGIB), rebleeding remains a major concern.

Aim: To assess the role of prophylactic transcatheter arterial embolization (PTAE) added to successful hemostatic treatment among NVUGIB patients.

Methods: We searched three databases from inception through October 19, 2020. Randomized controlled trials (RCTs) and observational cohort studies were eligible. Studies compared patients with NVUGIB receiving PTAE to those who did not get PTAE. Investigated outcomes were rebleeding, mortality, reintervention, need for surgery and transfusion, length of hospital (LOH), and intensive care unit (ICU) stay. In the quantitative synthesis, odds ratios (ORs) and weighted mean differences (WMDs) were calculated with the random-effects model and interpreted with 95% confidence intervals (CIs).

Results: We included a total of 3 RCTs and 9 observational studies with a total of 1329 patients, with 486 in the intervention group. PTAE was associated with lower odds of rebleeding (OR = 0.48, 95%CI: 0.29-0.78). There was no difference in the 30-d mortality rates (OR = 0.82, 95%CI: 0.39-1.72) between the PTAE and control groups. Patients who underwent PTAE treatment had a lower chance for reintervention (OR = 0.48, 95%CI: 0.31-0.76) or rescue surgery (OR = 0.35, 95%CI: 0.14-0.92). The LOH and ICU stay was shorter in the PTAE group, but the difference was non-significant [WMD = -3.77, 95%CI: (-8.00)-0.45; WMD = -1.33, 95%CI: (-2.84)-0.18, respectively].

Conclusion: PTAE is associated with lower odds of rebleeding and any reintervention in NVUGIB. However, further RCTs are needed to have a higher level of evidence.

Citing Articles

Prophylactic transarterial embolization in patients with bleeding peptic ulcers following endoscopic control of bleeding.

Zetner D, Roost I, Rosenberg J, Andresen K Cochrane Database Syst Rev. 2025; 2:CD014999.

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Preliminary report on embolization with quick-soluble gelatin sponge particles for angiographically negative acute gastrointestinal bleeding.

Alali M, Cao C, Shin J, Jeon G, Zeng C, Park J Sci Rep. 2024; 14(1):6438.

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Embolization for acute nonvariceal bleeding of upper and lower gastrointestinal tract: a systematic review.

Ini C, Distefano G, Sanfilippo F, Castiglione D, Falsaperla D, Giurazza F CVIR Endovasc. 2023; 6(1):18.

PMID: 36988839 PMC: 10060444. DOI: 10.1186/s42155-023-00360-3.

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