Endoscopic hemostasis combined with vascular interventional therapy for acute nonvariceal upper gastrointestinal...

Acute nonvariceal upper gastrointestinal bleeding (NVUGIB) is a life-threatening emergency. Endoscopic hemostasis and vascular interventional therapy are two major minimally invasive treatment strategies. Although these modalities are widely used, their comparative efficacy and safety across different patient populations and anatomical sites remain controversial.

To evaluate the clinical outcomes and safety of endoscopic hemostasis combined with vascular interventional therapy for NVUGIB.

A systematic search was done on PubMed, EMBASE, Cochrane Library, and Web of Science (from database establishment to April 2025). Randomized controlled trial (RCT) quality was assessed via Cochrane RoB 2.0, and observational studies via the Critical Appraisal Skills Program. RevMan 5.4 was used for quantitative analysis; fixed/random-effects models were chosen through I²-assessed heterogeneity. Publication bias was checked using funnel plots and sensitivity analysis via model switching.

Twenty-one studies (3 RCTs, 12 single-group studies, and 6 retrospective cohort studies) with good quality were included. For single-group data, combined therapy had risk differences of 0.70 (clinical success), 0.24 (mortality), and 0.22 (rebleeding; all P < 0.00001, I² = 0). Moreover, the ≥ 60-year rebleeding risk difference was 0.43. Reintervention was found to differ by approach (Z = 3.03, P = 0.002, inter-subgroup I² = 99%). In the RCT and cohort studies, combined vs standard therapy had similar initial hemostasis (Z = 0.04, P = 0.97) and mortality (Z = 1.56, P = 0.12) but lower rebleeding (Z = 3.26/P = 0.001; Z = 2.95/P = 0.03). Symmetrical funnel plots and robust sensitivity analysis showed no publication bias.

Combined endoscopic hemostasis and vascular interventional therapy for acute NVUGIB can significantly reduce rebleeding, without differences in mortality. Age and vascular interventional methods may influence the therapeutic efficacy.