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A systematic review of transarterial embolization versus emergency surgery in treatment of major nonvariceal upper gastrointestinal bleeding
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Beggs, Andrew, Dilworth, Mark, Powell, Susan, Atherton, Helen and Griffiths, Ewen (2014) A systematic review of transarterial embolization versus emergency surgery in treatment of major nonvariceal upper gastrointestinal bleeding. Clinical and Experimental Gastroenterology, 2014 (7). pp. 93-104. doi:10.2147/CEG.S56725 ISSN 1178-7023.
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WRAP_CEG-56725-a-systematic-review---meta-analysis-of-trans-arterial-emboli_041614.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial. Download (693Kb) | Preview |
Official URL: http://dx.doi.org/10.2147/CEG.S56725
Abstract
Background: Emergency surgery or transarterial embolization (TAE) are options for the treatment of recurrent or refractory nonvariceal upper gastrointestinal bleeding. Surgery has the disadvantage of high rates of postoperative morbidity and mortality. Embolization has become more available and has the advantage of avoiding laparotomy in this often unfit and elderly population.
Objective: To carry out a systematic review and meta-analysis of all studies that have directly compared TAE with emergency surgery in the treatment of major upper gastrointestinal bleeding that has failed therapeutic upper gastrointestinal endoscopy.
Methods: A literature search of Ovid MEDLINE, Embase, and Google Scholar was performed. The primary outcomes were all-cause mortality and rates of rebleeding. The secondary outcomes were length of stay and postoperative complications.
Results: A total of nine studies with 711 patients (347 who had embolization and 364 who had surgery) were analyzed. Patients in the TAE group were more likely to have ischemic heart disease (odds ratio [OR] =1.99; 95% confidence interval [CI]: 1.33, 2.98; P=0.0008; I2=67% [random effects model]) and be coagulopathic (pooled OR =2.23; 95% CI: 1.29, 3.87; P=0.004; I2=33% [fixed effects model]). Compared with TAE, surgery was associated with a lower risk of rebleeding (OR =0.41; 95% CI: 0.22, 0.77; P<0.0001; I2=55% [random effects]). There was no difference in mortality (OR =0.70; 95% CI: 0.48, 1.02; P=0.06; I2=44% [fixed effects]) between TAE and surgery.
Conclusion: When compared with surgery, TAE had a significant increased risk of rebleeding rates after TAE; however, there were no differences in mortality rates. These findings are subject to multiple sources of bias due to poor quality studies. These findings support the need for a well-designed clinical trial to ascertain which technique is superior.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Medical radiology, Therapeutic embolization | ||||||||
Journal or Publication Title: | Clinical and Experimental Gastroenterology | ||||||||
Publisher: | Dove Medical Press Ltd | ||||||||
ISSN: | 1178-7023 | ||||||||
Official Date: | 16 April 2014 | ||||||||
Dates: |
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Volume: | 2014 | ||||||||
Number: | 7 | ||||||||
Number of Pages: | 12 | ||||||||
Page Range: | pp. 93-104 | ||||||||
DOI: | 10.2147/CEG.S56725 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Date of first compliant deposit: | 26 February 2016 | ||||||||
Date of first compliant Open Access: | 1 March 2016 | ||||||||
Funder: | Wellcome Trust (London, England), National Institute for Health Research (Great Britain) (NIHR) | ||||||||
Grant number: | 102732/Z/13/| (WT) |
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