Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2021; 27(40): 6985-6999
Published online Oct 28, 2021. doi: 10.3748/wjg.v27.i40.6985
Prophylactic transcatheter arterial embolization reduces rebleeding in non-variceal upper gastrointestinal bleeding: A meta-analysis
Eszter Boros, Zoltán Sipos, Péter Hegyi, Brigitta Teutsch, Levente Frim, Szilárd Váncsa, Szabolcs Kiss, Fanni Dembrovszky, Eduard Oštarijaš, Andrew Shawyer, Bálint Erőss
Eszter Boros, Zoltán Sipos, Péter Hegyi, Brigitta Teutsch, Levente Frim, Szilárd Váncsa, Szabolcs Kiss, Fanni Dembrovszky, Eduard Oštarijaš, Bálint Erőss, Institute for Translational Medicine, University of Pecs, Medical School, Pécs 7624, Hungary
Eszter Boros, First Department of Internal Medicine, St. George University Teaching Hospital of County Fejér, Székesfehérvár 8000, Hungary
Péter Hegyi, Szentágothai Research Center, University of Pecs, Pécs 7624, Hungary
Szabolcs Kiss, Doctoral School of Clinical Medicine, University of Szeged, Szeged 6720, Hungary
Andrew Shawyer, Department of Interventional Radiology, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, United Kingdom
Author contributions: Boros E, Sipos Z, Hegyi P, Teutsch B, Frim L, Váncsa S, Kiss S, Dembrovszky F, Oštarijaš E, Shawyer A, and Erőss B provided the conceptualization; Boros E is the project administration; Boros E and Sipos Z formally analyze the original draft; Boros E and Teutsch B did the systematic search and selection, and wrote the original draft; Sipos Z made the visualisation, and wrote the original draft; Hegyi P contributed to the funding acquisition; Hegyi P, Frim L, Váncsa S, Kiss S, Dembrovszky F, Oštarijaš E, and Shawyer A wrote, reviewed and edited the manuscript; Frim L contributed to the data curation, quality and risk assessment; Váncsa S and Kiss S provided the methodology, and made the data curation; Dembrovszky F provided the methodology, and made the quality and risk assessment; Oštarijaš E did the visualisation; Erőss B did the conceptualization, supervision, and wrote the original draft; All authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript.
Supported by Economic Development and Innovation Operative Programme Grant, No. GINOP 2.3.2-15-2016-00048 and No. GINOP-2.3.4-15-2020-00010; and Human Resources Development Operational Programme Grant, No. EFOP-3.6.2-16-2017-00006 and No. EFOP-3.6.1.-16-2016-00004.
Conflict-of-interest statement: No conflict of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2020 Checklist, and was prepared and revised according to the PRISMA 2020 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bálint Erőss, MD, PhD, Assistant Professor, Doctor, Institute for Translational Medicine, University of Pecs, Medical School, 12 Szigeti Street, Pécs 7624, Hungary. eross.balint@pte.hu
Received: June 16, 2021
Peer-review started: June 16, 2021
First decision: July 14, 2021
Revised: July 25, 2021
Accepted: September 16, 2021
Article in press: September 16, 2021
Published online: October 28, 2021
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 19th, 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.

Keywords: Prophylactic transcatheter arterial embolization, Non-variceal upper gastrointestinal bleeding, Rebleeding, Reintervention, Meta-analysis, Review

Core Tip: Rebleeding remains a significant concern in patients with non-variceal upper gastrointestinal bleeding (NVUGIB), despite the improvements in endoscopic and pharmacologic treatments. Our systematic review and meta-analysis indicate that prophylactic transcatheter arterial embolization (PTAE) compared to standard of care is accompanied by lower odds of rebleeding, need for rescue surgery, and reinterventions NVUGIB. However, we could not justify a beneficial effect of PTAE on mortality rates compared with the standard of care. In line with our results, we suggest using PTAE in selected cases, where risk stratification predicts high rebleeding risk or the anatomical situation makes the secure and permanent endoscopic hemostasis impossible.