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
ARTICLE HIGHLIGHTS
Research background

The prevention of rebleeding is one of the main goals in managing non-variceal upper gastrointestinal bleeding (NVUGIB). Prophylactic transcatheter arterial embolization (PTAE) can be used in NVUGIB as second-line therapy.

Research motivation

The results of the individual studies about the beneficial effects of PTAE among NVUGIB patients were contradictory.

Research objectives

The authors aimed to carry out a comprehensive systematic review and meta-analysis. The authors compared the PTAE to no embolization as a second line, prophylactic treatment among NVUGIB patients.

Research methods

The authors conducted a systematic search in three databases (MEDLINE, EMBASE, CENTRAL). The eligible studies compared patients with NVUGIB receiving PTAE to those who did not get PTAE. The authors calculated odds ratios (ORs) with 95% confidence intervals (CI) for rebleeding, mortality, reintervention, need for surgery, and weighted mean differences (WMDs) of need for transfusion, length of hospital (LOH), and intensive care unit (ICU) stay.

Research results

PTAE was associated with significantly lower odds of rebleeding, reintervention and rescue surgery (OR = 0.48, 95%CI: 0.29–0.78; OR = 0.48, 95%CI: 0.31–0.76; OR = 0.35, 95%CI: 0.14–0.92; respectively). There was no significant difference in the mortality rates, LOH, and ICU stays between the PTAE and control groups. The quality of evidence for every outcome in our meta-analysis is very low based on the GRADE framework.

Research conclusions

The results suggest that PTAE is a reasonable therapeutic choice to prevent rebleeding or reintervention in NVUGIB, although it did not improve the mortality rates of NVUGIB.

Research perspectives

Further randomized controlled trials are needed about the use of PTAE. We also propose a clinical trial that could recommend a new risk stratification tool of NVUGIB, helping clinicians choose between treatment options.