Efficacy and Safety of Prophylactic Transarterial Embolization Combined with Endoscopy in High-Risk Peptic Ulcer Disease Patients: A Meta-Analysis

Tuesday, April 1, 2025

3:09 PM – 3:18 PM CT

Location: Music City Center, 201 AB

Presenting Author(s)

Ali Husnain, MD (he/him/his)

Postdoctoral Research Fellow
Northwestern University, United States

Author/Co-author(s)

MS

Muhammad Shahzil, MD

Resident Phyisician
Penn State Health, United States
Arsalan Nadeem, MBBS (he/him/his)

Postdoctoral Research Fellow
Northwestern University, United States
LM

Luqman Munir, MBBS

Medical Student
KEMU, Pakistan
AQ

Ali Akram Qureshi, MBBS

Medical Student
KEMU, Pakistan
MS

Mahum Shaukat, MBBS

Medical Student
Aziz Fatima Medical College, Pakistan

Purpose: Acute upper gastrointestinal bleeding (UGIB) from peptic ulcer disease (PUD) is a critical condition with a high mortality risk, particularly with recurrent bleeding. Endoscopic intervention is the standard treatment but fails in 20% of cases. Transarterial embolization (TAE) has emerged as a valuable alternative, especially for high-risk patients. This meta-analysis aims to evaluate the efficacy and safety of prophylactic TAE (PTAE) in managing high-risk PUD in addition to endoscopy, hypothesizing that it can reduce rebleeding and mortality rates compared to endoscopy alone.

Materials and Methods:
This meta-analysis followed Cochrane guidelines and PRISMA standards, comparing PTAE plus endoscopy versus endoscopy alone for PUD management. A comprehensive search was conducted across CENTRAL, MEDLINE, Embase, and Web of Science databases until March 2023. Inclusion criteria targeted randomized controlled trials (RCTs) and observational studies with adult participants having PUD. Data extraction followed PICOS criteria and was performed using a predefined Excel template. Statistical analyses utilized RevMan with a random-effects model, considering results significant at p < 0.05.

Results:
Of the 9455 screened studies, seven studies with 1165 peptic ulcer patients were included. The PTAE plus endoscopic group had 387 patients, and the endoscopic group had 727 patients. Primary outcomes assessed included rebleeding, mortality, and the need for reintervention. Rebleeding was significantly reduced in the PTAE group (OR: 0.42; 95% CI: 0.22, 0.77) as well as mortality (OR: 0.39; 95% CI: 0.22, 0.69). The need for reintervention showed no significant difference between the groups (OR: 0.97; 95% CI: 0.38, 2.51). Secondary outcomes included the need for surgery (OR: 0.54; 95% CI: 0.25, 1.16), hospital stay duration (mean difference: -1.43 days; 95% CI: -3.15, 0.29), red blood cell transfusion (mean difference: 0.89 units; 95% CI: -0.61, 2.39), and ICU stay, which was significantly shorter in the PTAE group (mean difference: -0.61 days; 95% CI: -1.08, -0.14).

Conclusion: This meta-analysis indicates that PTAE in combination with endoscopy is effective in reducing rebleeding and mortality in patients with UGIB from PUD without significantly increasing the need for further interventions or affecting hospital stay duration. Future research should focus on larger randomized controlled trials to further validate these findings and explore additional benefits of PTAE in high-risk PUD patients.