Khan Shahryar, Khan Mashal Alam, Jadoon Ahmed Khan, Khan Ahmad, Khan Danish Ali, Gohar Mehwish, Shafiq Muhammad, Elahi Muhammad Waqar, Shahzil Muhammad, Esfandyari Tuba
Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Department of Medicine, Khyber Medical University, Peshawar, Pakistan.
Gastroenterology Res. 2025 Jun;18(3):139-148. doi: 10.14740/gr2041. Epub 2025 Jun 4.
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).
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.
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.
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.
再出血是一个重大挑战，也是非静脉曲张性上消化道出血（NVUGIB）的严重并发症。预防性经导管动脉栓塞术（P-TAE）已成为高危病例的一种潜在治疗策略。本研究旨在评估在无出血血管造影证据或治疗性动脉栓塞术（TAE）的情况下，P-TAE与未栓塞（NE）相比的疗效和安全性。
本研究系统检索了从数据库建立至2024年11月15日的Medline和Embase数据库。主要结局是总体再出血率，次要结局包括死亡率、额外干预的需求、输血需求、住院/重症监护病房（ICU）住院时间以及与手术相关的不良事件。
荟萃分析纳入了10项研究，总共有1253例患者。与NE相比，汇总数据表明P-TAE与再出血率显著降低（优势比（OR）：0.69，95%置信区间（CI）：0.39 - 1.22，P = 0.20）或全因死亡率（OR：0.70，95% CI：0.40 - 1.23）无关。尽管P-TAE在重复干预率、输血率和缩短住院时间方面有降低趋势，但这些差异无统计学意义。相反，P-TAE和TAE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）相似。分析发现两种栓塞方法在不良事件或重复手术需求方面无显著差异。
本综述表明，与高危NVUGIB的标准治疗相比，P-TAE可能不会显著降低再出血率或死亡率。然而，目前的研究结果仍不确定，需要进一步进行更大样本量的全面研究来最终证实这些观察结果。
