Prophylactic angiographic embolisation after endoscopic treatment of bleeding for high-risk peptic ulcers: what are the more appropriate indications?

Tong, Huan; Lan, Tian; Tang, Chengwei

doi:10.1136/gutjnl-2019-319818

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…Investigating a subset of patients with ulcers 15mm or more in size, PTAE significantly reduced the risk of rebleeding (23.1% vs 4.5%, P = 0.027)[ 10 ]. A similar improvement in the rebleeding rate after PTAE was observed in some cohort studies[ 11 - 13 ].…”

Section: Introductionsupporting

confidence: 85%

“…The 14 included studies are summarized in Table 1 . We included in the quantitative synthesis three randomized controlled trials[ 10 , 25 , 26 ], two prospective[ 11 , 12 ], and seven retrospective cohort studies[ 13 , 27 - 32 ]. The source of bleeding was peptic ulcer lesions in eight studies[ 10 - 13 , 25 , 29 , 30 , 32 ], while in four studies[ 26 - 28 , 31 ], NVUGIB lesion was used as a generic term for various bleeding sources ( e.g.…”

Section: Resultsmentioning

confidence: 99%

“…Nevertheless, risk stratification is essential before choosing between multiple possible treatment modalities in the case of NVUGIB. Several studies[ 10 - 13 , 25 ] used the Forrest classification, Rockall score, or the American Society of Anesthesiologists score to assess the baseline risk of rebleeding or mortality among the patients, and it was approximately the same between the PTAE and the control group.…”

Section: Discussionmentioning

confidence: 99%

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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: Introductionsupporting

confidence: 85%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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Prophylactic transcatheter angiographic embolization reduces Forrest IIa ulcer rebleeding

Lan¹,

Tong²,

Qian

et al. 2021

Medicine

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The application of transcatheter angiographic embolization (TAE) is controversial in the treatment of ulcer bleeding. This study aims to determine rebleeding risk factors and evaluate the efficacy of prophylactic TAE (p-TAE) following endoscopic hemostasis in rebleeding prevention of Forrest lla ulcers. The medical records of Forrest lla ulcer patients who underwent endoscopic hemostasis (E group) and endoscopic hemostasis plus p-TAE (E + p-TAE group) in West China Hospital from May 2009 to May 2018 were retrospectively reviewed. Baseline characteristics, clinical efficacy, and rebleeding risk factors were analyzed. As a result, a total of 102 patients were included, with 75 and 27 patients in E and E + p-TAE group, respectively. Most of the baseline data in E and E + p-TAE group were similar except for the proportion of protruded non-bleeding visible vessel (NBVV) (E group vs E + p-TAE group, 50.7% vs 74.1%, P = .035). The rebleeding rate of E + p-TAE group (3.7%) was significantly lower than E group (24.0%) (P = .02). The protruded NBVV (OR: 6.896, 95% confidence interval [CI]: 1.532–30.642, P = .01) and employment of p-TAE (OR: 0.038, 95% CI: 0.003–0.448, P = .009) were identified as independent risk factors for Forrest IIa ulcer rebleeding. Additionally, log-rank test indicated the rebleeding occurrence was greatly reduced by p-TAE in patients with protruded NBVVs (P = .006). In conclusion, the protruded NBVV and employment of p-TAE were the independent risk factors tightly associated with rebleeding of Forrest IIa ulcer. P-TAE following endoscopic hemostasis could effectively prevent Forrest IIa ulcer from rebleeding.

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Prophylactic Transarterial Embolization for Gastrointestinal Bleeding

Anosov,

Domrachev,

Ovchinnikov

et al. 2023

Dok. gastroenterol.

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Prophylactic angiographic embolisation after endoscopic treatment of bleeding for high-risk peptic ulcers: what are the more appropriate indications?

Cited by 3 publications

References 4 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

Prophylactic transcatheter angiographic embolization reduces Forrest IIa ulcer rebleeding

Prophylactic Transarterial Embolization for Gastrointestinal Bleeding

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