Comparison of Prophylactic Transcatheter Arterial Embolization and Standard Therapy in High-Risk Non-Variceal Upper Gastrointestinal Bleeding: A Meta-Analysis.

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY
Gastroenterology Research Pub Date : 2025-06-01 Epub Date: 2025-06-04 DOI:10.14740/gr2041
Shahryar Khan, Mashal Alam Khan, Ahmed Khan Jadoon, Ahmad Khan, Danish Ali Khan, Mehwish Gohar, Muhammad Shafiq, Muhammad Waqar Elahi, Muhammad Shahzil, Tuba Esfandyari
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Abstract

Background: Rebleeding is a major challenge and a serious complication of non-variceal upper gastrointestinal bleeding (NVUGIB). Prophylactic transcatheter arterial embolization (P-TAE) has emerged as a potential management strategy for high-risk cases. This study aimed to evaluate the efficacy and safety of P-TAE compared with no embolization (NE) in the absence of angiographic evidence of bleeding or therapeutic arterial embolization (TAE).

Methods: The study systematically searched Medline and Embase databases from inception until November 15, 2024. The primary outcome was the overall rebleeding rate, while secondary outcomes included mortality, need for additional interventions, transfusion requirements, hospital/intensive care unit (ICU) stay, and procedure-related adverse events.

Results: The meta-analysis included 10 studies with a total population of 1,253 patients. Compared to NE, the pooled data indicated that P-TAE was not associated with significantly reduced rates of rebleeding (odds ratio (OR): 0.69, 95% confidence interval (CI): 0.39 - 1.22, P = 0.20) or all-cause mortality (OR: 0.70, 95% CI: 0.40 - 1.23). Although P-TAE trended towards lower rates of repeat interventions, blood transfusions, and shorter hospital stays, these differences were not statistically significant. Conversely, P-TAE and TAE had similar rates of rebleeding (OR: 1.08, 95% CI: 0.70 - 1.68, P = 0.05) and all-cause mortality (OR: 0.72, 95% CI: 0.34 - 1.51, P = 0.39). The analysis found no significant differences in adverse events or the need for repeat procedures between the two embolization approaches.

Conclusion: This review suggests that P-TAE may not significantly reduce rebleeding or mortality compared with standard therapy for high-risk NVUGIB. However, the current findings remain inconclusive, and further comprehensive research with larger sample sizes is required to conclusively substantiate these observations.

预防性经导管动脉栓塞和标准治疗高危非静脉曲张上消化道出血的比较:荟萃分析。
背景:再出血是非静脉曲张性上消化道出血(NVUGIB)的主要挑战和严重并发症。预防性经导管动脉栓塞(P-TAE)已成为高风险病例的潜在管理策略。本研究旨在评估在没有血管造影证据显示出血或治疗性动脉栓塞(TAE)的情况下,P-TAE与未栓塞(NE)的疗效和安全性。方法:本研究系统检索Medline和Embase数据库,检索时间自成立至2024年11月15日。主要结局是总再出血率,次要结局包括死亡率、额外干预的需要、输血要求、住院/重症监护病房(ICU)住院时间和手术相关不良事件。结果:荟萃分析包括10项研究,共1253例患者。与NE相比,合并数据显示,P- tae与再出血率(优势比(OR): 0.69, 95%可信区间(CI): 0.39 - 1.22, P = 0.20)或全因死亡率(OR: 0.70, 95% CI: 0.40 - 1.23)的显著降低无关。虽然P-TAE倾向于较低的重复干预率、输血率和较短的住院时间,但这些差异在统计学上并不显著。相反,P-TAE和TAE有相似的再出血率(OR: 1.08, 95% CI: 0.70 - 1.68, P = 0.05)和全因死亡率(OR: 0.72, 95% CI: 0.34 - 1.51, P = 0.39)。分析发现两种栓塞方法在不良事件或重复手术方面没有显著差异。结论:本综述表明,与标准治疗相比,P-TAE可能不会显著降低高危NVUGIB的再出血或死亡率。然而,目前的发现仍然是不确定的,需要进一步的更大样本量的全面研究来最终证实这些观察结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Gastroenterology Research
Gastroenterology Research GASTROENTEROLOGY & HEPATOLOGY-
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