Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, 21079 Dijon, France.
Department of Gastroenterology and Hepatology, François-Mitterrand University Hospital, 21079 Dijon, France.
Diagn Interv Imaging. 2021 Jul-Aug;102(7-8):479-487. doi: 10.1016/j.diii.2021.03.004. Epub 2021 Apr 20.
To perform a systematic review and meta-analysis to determine the safety, efficacy, and outcomes of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) as the single embolic agent for the management of non-variceal upper and lower gastrointestinal bleeding (GIB).
A literature search using MEDLINE/PubMed, EMBASE, and SCOPUS databases was performed for studies published from January 1980 to December 2019. Data from eligible studies were extracted and evaluated by two independent reviewers. Exclusion criteria were sample size <5, article reporting the use of NBCA with other embolic agents, no extractable data, and duplicate reports. Technical success, clinical success, 30-day rebleeding, 30-day overall and major complications, and 30-day mortality were evaluated. The estimated overall rates were calculated with their 95% confidence intervals, based on each study rate, weighted by the number of patients involved in each study. Heterogeneity across studies was assessed using the Q test and I statistic.
Fifteen studies with 574 patients were included. For upper GIB (331 patients), the technical and clinical success rates, and 30-day rebleeding and mortality rates, were 98.8% (328 of 331 patients) and 88.0% (237 of 300 patients), and 12.5% (69 of 314 patients) and 15.9% (68 of 331 patients), respectively. Thirty-day overall and major complications occurred in 14.3% (28 of 331 patients) and 2.7% (7 of 331 patients) of patients, respectively. For lower GIB (243 patients), the technical and clinical success rates, and 30-day rebleeding and mortality rates, were 98.8% (78 of 78 patients) and 78.0% (145 of 189 patients), and 15.7% (33 of 218 patients) and 12.7% (14 of 78 patients), respectively. Thirty-day overall and major complications occurred in 13.0% (25 of 228 patients) and 8.6% (19 of 228 patients) of patients, respectively.
TAE with NBCA is safe and effective for treating non-variceal GIB, with high clinical success and very low major complication rates.
进行系统评价和荟萃分析，以确定单纯使用 N-丁基氰基丙烯酸酯（NBCA）作为栓塞剂治疗非静脉曲张性上、下消化道出血（GIB）的安全性、疗效和结局。
检索 1980 年 1 月至 2019 年 12 月间 MEDLINE/PubMed、EMBASE 和 SCOPUS 数据库中的文献。由两名独立的评审员提取和评估合格研究的数据。排除标准为样本量＜5、报告使用 NBCA 联合其他栓塞剂、无可提取数据和重复报告。评估技术成功率、临床成功率、30 天再出血、30 天总体和主要并发症、30 天死亡率。根据每项研究的发生率，通过每个研究涉及的患者数量进行加权，计算总体估计率及其 95%置信区间。使用 Q 检验和 I 统计评估研究间的异质性。
纳入 15 项研究，共 574 例患者。对于上消化道出血（331 例患者），技术和临床成功率、30 天再出血率和死亡率分别为 98.8%（328/331 例）和 88.0%（237/300 例），12.5%（69/314 例）和 15.9%（68/331 例）。30 天总体和主要并发症发生率分别为 14.3%（28/331 例）和 2.7%（7/331 例）。对于下消化道出血（243 例患者），技术和临床成功率、30 天再出血率和死亡率分别为 98.8%（78/78 例）和 78.0%（145/189 例），15.7%（33/218 例）和 12.7%（14/78 例）。30 天总体和主要并发症发生率分别为 13.0%（25/228 例）和 8.6%（19/228 例）。
使用 NBCA 的 TAE 治疗非静脉曲张性 GIB 安全有效，临床成功率高，主要并发症发生率极低。
