Transcatheter arterial embolization versus surgery for refractory non-variceal upper gastrointestinal bleeding: a meta-analysis

Tarasconi, Antonio; Baiocchi, Gian Luca; Pattonieri, Vittoria; Perrone, Gennaro; Abongwa, Hariscine K.; Molfino, Sarah; Portolani, Nazario; Sartelli, Massimo; Saverio, Salomone Di; Heyer, Arianna; Ansaloni, Luca; Catena, Fausto; Catena, Fausto

doi:10.1186/s13017-019-0223-8

Cited by 53 publications

(44 citation statements)

References 37 publications

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“…A significantly lower rate of post-procedural complications was reported in the angioembolization cohort. The latest meta-analysis [137] found similar results, but interestingly found a slight drift toward a lower mortality for the angioembolization group.…”

Section: Angiography Embolizationmentioning

confidence: 61%

“…One prospective and multiple retrospective cohort studies comparing outcomes between patients undergoing angioembolization with those undergoing surgery for rebleeding after failed endoscopic control are available. These studies were summarized in three meta-analysis [135][136][137]. Kyaw et al summarized 6 retrospective cohort studies: surgery was found to significantly reduce the likelihood of further (post-intervention) hemorrhage, and was associated with a trend towards a reduced need for further intervention.…”

Section: Angiography Embolizationmentioning

confidence: 99%

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Perforated and bleeding peptic ulcer: WSES guidelines

et al. 2020

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Background: Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment. Methods: The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached. Conclusions: The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.

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Section: Angiography Embolizationmentioning

confidence: 61%

Section: Angiography Embolizationmentioning

confidence: 99%

Perforated and bleeding peptic ulcer: WSES guidelines

et al. 2020

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“…Few RCTs have compared alternative treatment modalities in the management of patients with persistent ulcer bleeding. Meta-analyses and retrospective case series comparing transcatheter arterial embolization (TAE) and surgery suggest that patient outcomes following either approach are similar [127][128][129]. TAE, however, is associated with a higher failure rate in the control of bleeding [127][128][129] [132].…”

Section: Recommendationmentioning

confidence: 99%

Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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MAIN RECOMMENDATIONS 1 ESGE recommends in patients with acute upper gastrointestinal hemorrhage (UGIH) the use of the Glasgow–Blatchford Score (GBS) for pre-endoscopy risk stratification. Patients with GBS ≤ 1 are at very low risk of rebleeding, mortality within 30 days, or needing hospital-based intervention and can be safely managed as outpatients with outpatient endoscopy.Strong recommendation, moderate quality evidence. 2 ESGE recommends that in patients with acute UGIH who are taking low-dose aspirin as monotherapy for secondary cardiovascular prophylaxis, aspirin should not be interrupted. If for any reason it is interrupted, aspirin should be re-started as soon as possible, preferably within 3–5 days.Strong recommendation, moderate quality evidence. 3 ESGE recommends that following hemodynamic resuscitation, early (≤ 24 hours) upper gastrointestinal (GI) endoscopy should be performed. Strong recommendation, high quality evidence. 4 ESGE does not recommend urgent (≤ 12 hours) upper GI endoscopy since as compared to early endoscopy, patient outcomes are not improved. Strong recommendation, high quality evidence. 5 ESGE recommends for patients with actively bleeding ulcers (FIa, FIb), combination therapy using epinephrine injection plus a second hemostasis modality (contact thermal or mechanical therapy). Strong recommendation, high quality evidence. 6 ESGE recommends for patients with an ulcer with a nonbleeding visible vessel (FIIa), contact or noncontact thermal therapy, mechanical therapy, or injection of a sclerosing agent, each as monotherapy or in combination with epinephrine injection. Strong recommendation, high quality evidence. 7 ESGE suggests that in patients with persistent bleeding refractory to standard hemostasis modalities, the use of a topical hemostatic spray/powder or cap-mounted clip should be considered. Weak recommendation, low quality evidence. 8 ESGE recommends that for patients with clinical evidence of recurrent peptic ulcer hemorrhage, use of a cap-mounted clip should be considered. In the case of failure of this second attempt at endoscopic hemostasis, transcatheter angiographic embolization (TAE) should be considered. Surgery is indicated when TAE is not locally available or after failed TAE. Strong recommendation, moderate quality evidence. 9 ESGE recommends high dose proton pump inhibitor (PPI) therapy for patients who receive endoscopic hemostasis and for patients with FIIb ulcer stigmata (adherent clot) not treated endoscopically. (a) PPI therapy should be administered as an intravenous bolus followed by continuous infusion (e. g., 80 mg then 8 mg/hour) for 72 hours post endoscopy. (b) High dose PPI therapies given as intravenous bolus dosing (twice-daily) or in oral formulation (twice-daily) can be considered as alternative regimens.Strong recommendation, high quality evidence. 10 ESGE recommends that in patients who require ongoing anticoagulation therapy following acute NVUGIH (e. g., peptic ulcer hemorrhage), anticoagulation should be resumed as soon as the bleeding has been controlled, preferably within or soon after 7 days of the bleeding event, based on thromboembolic risk. The rapid onset of action of direct oral anticoagulants (DOACS), as compared to vitamin K antagonists (VKAs), must be considered in this context.Strong recommendation, low quality evidence.

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“…Transcatheter arterial embolization (TAE) is widely acknowledged for its effectiveness in treating brisk arterial bleeding 20 . It has largely replaced surgery as a rst-line therapy for UGIB refractory to endoscopic treatment due to its high e cacy and favorable safety pro le 21 . However, a subgroup of ulcers remains at high-risk of future rebleeding despite achieving hemostasis via endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic transcatheter arterial embolization for high-risk ulcers following endoscopic hemostasis: A meta-analysis

Qian

Liu

Patel

et al. 2020

Preprint

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Background: To conduct a meta-analysis to assess the safety and efficacy of prophylactic transcatheter arterial embolization (PTAE) for the treatment of high-risk bleeding peptic ulcers after achieving endoscopic hemostasis.Methods: PubMed and Cochrane Library were queried for full-text articles published up to December 2019. The following keywords were used: “prophylactic embolization”, “supplement embolization”, “gastrointestinal bleeding”, and “ulcer bleeding”. High-risk ulcers were defined based on endoscopic findings (i.e. large ulcers, Forrest class I-IIb) and/or clinical presentation (i.e. hypotension, decreased hemoglobin during endoscopy). Only comparative studies investigating PTAE versus conservative treatment after achieving endoscopic hemostasis were included. Baseline study characteristics, re-bleeding rate, need for surgery, mortality, and PTAE-related complication rates were investigated. Quantitative analyses were performed with STATA 15.1.Results: Among the five original studies included, a total of 265 patients received PTAE and 617 were managed conservatively after endoscopy. The rebleeding rate (6.8% vs 14.3%, p=0.003) and mortality (4.5% vs 8.8%, p=0.032) of patients from the PTAE group were lower than the control group. PTAE also reduced the cumulative need of future surgical intervention (3.0% vs 14.4%, p=0.005). The PTAE-related major and minor events were 0.75% and 14.4%, respectively. Conclusion: PTAE had therapeutic potentials in reducing rebleeding risk, need of surgical intervention, and morality in high-risk peptic ulcers after achieving endoscopic hemostasis. The embolization-associated adverse events were minimal. Future studies should aim to increase the sample size and resources for performing endovascular interventions.

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Transcatheter arterial embolization versus surgery for refractory non-variceal upper gastrointestinal bleeding: a meta-analysis

Cited by 53 publications

References 37 publications

Perforated and bleeding peptic ulcer: WSES guidelines

Perforated and bleeding peptic ulcer: WSES guidelines

Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Prophylactic transcatheter arterial embolization for high-risk ulcers following endoscopic hemostasis: A meta-analysis

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