Systematic Review and Meta-Analysis of Prophylactic Transarterial Embolization for High-Risk Bleeding Peptic Ulcer Disease

Chang, Jasmine; Lye, Tiffany Jian Ying; Zhu, Hong; Syn, Nicholas; Tang, Sarah Si Lin; Gogna, Apoorva; Chan, Weng Hoong; Ong, Hock Soo; Tan, Jeremy; Lim, Chin Hong

doi:10.1016/j.jvir.2020.12.005

Cited by 6 publications

(3 citation statements)

References 22 publications

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“…A recent meta-analysis of Chang et al [ 33 ] attempted to evaluate the role of PTAE in the management of patients with high-risk peptic ulcer bleeding. They included only 2 RCTs and 3 observational studies in their meta-analysis while narrowing their search to patients with a high risk of rebleeding.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic transcatheter arterial embolization reduces rebleeding in non-variceal upper gastrointestinal bleeding: A meta-analysis

Boros

Sipos

Hegyi

et al. 2021

WJG

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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 th , 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.

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Section: Discussionmentioning

confidence: 99%

Prophylactic transcatheter arterial embolization reduces rebleeding in non-variceal upper gastrointestinal bleeding: A meta-analysis

Boros

Sipos

Hegyi

et al. 2021

WJG

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“…However, in acute GI bleeding, conventional angiography frequently fails to detect active bleeding. Previous research has indicated rates of negative angiographic findings ranging between 24 and 78% 4,5 .Prophylactic embolization for angiographically negative GI bleeding (negative GI bleeding on conventional angiography) is known to be both controversial and effective, and the primary embolic materials have been gelatin sponge particles (GSPs) and coils [6][7][8][9] . Coils are permanent embolic materials and are considered unsuitable for prophylactic TAE because of the risk of coil migration; GSPs, on the other hand, take several weeks to be absorbed, which can lead to ischemia or infarction of the bowel 10,11 .Therefore, it is thought that the risk of bowel ischemia or infarction can be reduced if GSPs are absorbed more quickly.…”

mentioning

confidence: 99%

“…Prophylactic embolization for angiographically negative GI bleeding (negative GI bleeding on conventional angiography) is known to be both controversial and effective, and the primary embolic materials have been gelatin sponge particles (GSPs) and coils [6][7][8][9] . Coils are permanent embolic materials and are considered unsuitable for prophylactic TAE because of the risk of coil migration; GSPs, on the other hand, take several weeks to be absorbed, which can lead to ischemia or infarction of the bowel 10,11 .…”

mentioning

confidence: 99%

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

Alali,

Cao,

Shin

et al. 2024

Sci Rep

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Prophylactic embolization is usually performed using gelatin sponge particles, which are absorbed within several weeks, for managing angiographically negative gastrointestinal bleeding. This study aimed to evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) with quick-soluble gelatin sponge particles (QS-GSP) that dissolve in less than 4 h for treating angiographically negative gastrointestinal bleeding. We included ten patients (M:F = 7:3; mean age, 64.3 years) who underwent prophylactic TAE with QS-GSP for angiographically negative acute gastrointestinal bleeding between 2021 and 2023. The technical success rate of TAE, clinical outcomes focusing on rebleeding, and procedure-related complications were evaluated. The embolized arteries were the gastroduodenal (n = 3), jejunal (n = 4), and ileal (n = 3) arteries. QS-GSP (150–350 µm or 350–560 µm) were used alone (n = 8) or in combination with a coil (n = 1). A 100% technical success rate was accomplished. In 1 patient (10%), rebleeding occurred 2 days after prophylactic TAE of the gastroduodenal artery, and this was managed by repeat TAE. There were no procedure-related complications. The use of QS-GSP for prophylactic TAE appears to be safe and effective for controlling bleeding among patients with angiographically negative gastrointestinal bleeding. There were no cases of related ischemic complications of the embolized bowels likely attributable to recanalization of the affected arteries following biodegradation of QS-GSP.

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Risk factors for rebleeding and mortality following prophylactic transarterial embolization for patients with high-risk peptic ulcer bleeding: a single-center retrospective cohort study

Zetner,

Rasmussen,

Frykman

et al. 2024

Surg Endosc

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Background To investigate factors associated with risk for rebleeding and 30-day mortality following prophylactic transarterial embolization in patients with high-risk peptic ulcer bleeding. Methods We retrospectively reviewed medical records and included all patients who had undergone prophylactic embolization of the gastroduodenal artery at Rigshospitalet, Denmark, following an endoscopy-verified and treated peptic Sulcer bleeding, from 2016 to 2021. Data were collected from electronic health records and imaging from the embolization procedures. Primary outcomes were rebleeding and 30-day mortality. We performed logistical regression analyses for both outcomes with possible risk factors. Risk factors included: active bleeding; visible hemoclips; Rockall-score; anatomical variants; standardized embolization procedure; and number of endoscopies prior to embolization. Results We included 176 patients. Rebleeding occurred in 25% following embolization and 30-day mortality was 15%. Not undergoing a standardized embolization procedure increased the odds of both rebleeding (odds ratio 3.029, 95% confidence interval (CI) 1.395–6.579) and 30-day overall mortality by 3.262 (1.252–8.497). More than one endoscopy was associated with increased odds of rebleeding (odds ratio 2.369, 95% CI 1.088–5.158). High Rockall-score increased the odds of 30-day mortality (odds ratio 2.587, 95% CI 1.243–5.386). Active bleeding, visible hemoclips, and anatomical variants did not affect risk of rebleeding or 30-day mortality. Reasons for deviation from standard embolization procedure were anatomical variations, targeted treatment without embolizing the gastroduodenal artery, and technical failure. Conclusions Deviation from the standard embolization procedure increased the risk of rebleeding and 30-day mortality, more than one endoscopy prior to embolization was associated with higher odds of rebleeding, and a high Rockall-score increased the risk of 30-day mortality. We suggest that patients with these risk factors are monitored closely following embolization. Early detection of rebleeding may allow for proper and early re-intervention. Graphical abstract

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Systematic Review and Meta-Analysis of Prophylactic Transarterial Embolization for High-Risk Bleeding Peptic Ulcer Disease

Cited by 6 publications

References 22 publications

Prophylactic transcatheter arterial embolization reduces rebleeding in non-variceal upper gastrointestinal bleeding: A meta-analysis

Prophylactic transcatheter arterial embolization reduces rebleeding in non-variceal upper gastrointestinal bleeding: A meta-analysis

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

Risk factors for rebleeding and mortality following prophylactic transarterial embolization for patients with high-risk peptic ulcer bleeding: a single-center retrospective cohort study

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