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Embolization versus surgery for peptic ulcer bleeding after failed endoscopic hemostasis: a meta-analysis
Moe Kyaw1, Yee Tse1, Daphne Ang2
1Institute of Digestive Diseases, Chinese University of Hong Kong, Shatin, Hong Kong.
Endoscopy International Open
|July 3, 2015
Summary
Transcatheter arterial embolization (TAE) for recurrent upper gastrointestinal bleeding shows a higher rebleeding risk than surgery. Surgery provides more definitive hemostasis without increasing mortality or need for further interventions.
Area of Science:
- Interventional Gastroenterology
- Surgical Gastroenterology
- Comparative Effectiveness Research
Background:
- Recurrent nonvariceal upper gastrointestinal bleeding (NVUGIB) poses significant management challenges.
- Endoscopic hemostasis may fail, necessitating alternative treatment strategies.
- Transcatheter arterial embolization (TAE) and surgery are options for refractory NVUGIB.
Purpose of the Study:
- To compare the efficacy of TAE versus surgery for NVUGIB after endoscopic hemostasis failure.
- To evaluate rebleeding rates, mortality, and need for additional interventions.
- To inform clinical decision-making in managing complex upper GI bleeding.
Main Methods:
- A meta-analysis of 6 retrospective comparative studies was performed.
- Literature search included OVID, MEDLINE, EMBASE, and conference abstracts.
- Outcome measures: rebleeding, all-cause mortality, and need for additional interventions.
Main Results:
- TAE was associated with a significantly higher rebleeding rate (RR 1.82) compared to surgery.
- No significant differences were found in all-cause mortality or need for additional interventions.
- Sensitivity analysis confirmed higher rebleeding risk with TAE, even after adjusting for age differences.
Conclusions:
- Surgery appears more effective in definitively securing hemostasis for NVUGIB compared to TAE.
- TAE patients were older and potentially had poorer health status.
- Further randomized controlled trials are warranted to definitively compare TAE and surgery for NVUGIB.
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