Embolization for non-variceal upper gastrointestinal tract haemorrhage: A systematic review

S. Mirsadraee, P. Tirukonda, A. Nicholson, S. M. Everett, S. J. McPherson

Research output: Contribution to journalArticlepeer-review

Abstract

AIM: To assess the published evidence on the endovascular treatment of non-variceal upper gastrointestinal haemorrhage. MATERIALS AND

METHODS: An Ovid Medline search of published literature was performed (1966-2009). Non-English literature, experimental studies, variceal haemorrhage and case series with fewer than five patients were excluded. The search yielded 1888 abstracts. Thirty-five articles were selected for final analysis.

RESULTS: The total number of pooled patients was 927. The technical and clinical success of embolization ranged from 52-100% and 44-100%, respectively. The pooled mean technical/clinical success rate in primary upper gastrointestinal tract haemorrhage (PUGITH) only, transpapillary haemorrhage (TPH) only, and mixed studies were 84%/67%, 93%/89%, and 93%/64%, respectively. Clinical outcome was adversely affected by multi-organ failure, shock, corticosteroids, transfusion, and coagulopathy. The anatomical source of haemorrhage and procedural variables did not affect the outcome. A successful embolization improved survival by 13.3 times. Retrospective comparison with surgery demonstrated equivalent mortality and clinical success, despite embolization being applied to a more elderly population with a higher prevalence of co-morbidities.

CONCLUSIONS: Embolization is effective in this very difficult cohort of patients with outcomes similar to surgery. (C) 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)500-509
Number of pages10
JournalClinical Radiology
Volume66
Issue number6
DOIs
Publication statusPublished - Jun 2011

Keywords

  • Embolization, Therapeutic
  • Endoscopy, Gastrointestinal
  • Evidence-Based Medicine
  • Female
  • Gastrointestinal Hemorrhage
  • Hemostasis, Endoscopic
  • Humans
  • Male
  • Risk Factors

Cite this