Percutaneous Sclerotherapy Versus Transarterial Chemoembolization for Giant Hepatic Hemangiomas: A Systematic Review...

This study aims to systematically evaluate the efficacy and safety of different bleomycin administration routes for treating GHHs, with a subgroup analysis comparing Transarterial chemoembolization (TACE) and percutaneous sclerotherapy (PS).

A systematic literature search was conducted in MEDLINE, Scopus, and Web of Science from inception through May 6, 2025. Studies included reporting clinical and radiological outcomes after PS and TACE for GHHs (≥ 4 cm). Primary outcomes included technical success (complete and accurate application as predetermined in the study protocol), safety outcomes, clinical (symptom relief without additional intervention), and radiological success (≥ 50% size reduction and/or lack of enhancement on follow-up imaging). The outcomes were analyzed using a random-effects meta-analysis 106 1586.

A total of 17 studies, including 1692 patients (1586 treated with TACE and 106 with PS) and 1825 GHHs, were included. Among these, 13 studies assessed TACE, and four studies evaluated PS. The overall technical success rate was 100%, with pooled clinical and radiological success rates of 96.93% and 81.75%, respectively. In subgroup analyses, both TACE and PS achieved 100% technical success. TACE showed slightly higher clinical success, at 99.9%, compared to PS at 89.73%, although the difference was not statistically significant (p = 0.15). Radiological success was comparable (TACE: 81.9%, PS: 81.29%). Major complications were rare (0.27%, 95% CI: 0-0.55%). No significant differences were observed in major complication rates (TACE: 0.26%, PS: 0.85%, p = 0.67), total complications (p = 0.48), or procedure-related morbidity.

Both TACE and PS are effective treatments for GHHs, with PS showing a lower systemic complication rate.