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Research article
Prophylactic transcatheter arterial embolization for high-risk ulcers following endoscopic hemostasis: A meta-analysis
Chenyu Liu
George Washington University Medical Center
Corresponding Author
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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.
Keywords
embolization, gastrointestinal bleeding, interventional radiology, ulcer
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CURRENT STATUS: Under Review
Version 1
Posted 19 Nov, 2020
No community comments so far
Editorial decision: Major revision
On 10 Jan, 2021
Review #1 received
Received 07 Jan, 2021
Review #2 received
Received 23 Dec, 2020
Reviewer #2 agreed
On 12 Dec, 2020
Reviewers invited
Invitations sent on 10 Dec, 2020
Reviewer #1 agreed
On 10 Dec, 2020
Editor assigned
On 09 Dec, 2020
Editor invited
On 09 Dec, 2020
Submission checks complete
On 18 Nov, 2020
First submitted
On 11 Nov, 2020
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This preprint is under consideration at World Journal of Emergency Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Prophylactic transcatheter arterial embolization for high-risk ulcers following endoscopic hemostasis: A meta-analysis
Chenyu Liu
George Washington University Medical Center
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 19 Nov, 2020
No community comments so far
Editorial decision: Major revision
On 10 Jan, 2021
Review #1 received
Received 07 Jan, 2021
Review #2 received
Received 23 Dec, 2020
Reviewer #2 agreed
On 12 Dec, 2020
Reviewers invited
Invitations sent on 10 Dec, 2020
Reviewer #1 agreed
On 10 Dec, 2020
Editor assigned
On 09 Dec, 2020
Editor invited
On 09 Dec, 2020
Submission checks complete
On 18 Nov, 2020
First submitted
On 11 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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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