Efficacy and safety of transcatheter arterial embolization for lower gastrointestinal bleeding: a systematic review and meta-analysis of 58 clinical trials.

OBJECTIVE

Acute lower gastrointestinal bleeding (LGIB) is a common and life-threatening condition, particularly in elderly patients, characterized by high morbidity and mortality rates. While transcatheter arterial embolization (TAE) has been widely adopted as an essential interventional treatment, its efficacy and safety have yet to be thoroughly and systematically evaluated. This study aims to assess the safety, efficacy, and clinical outcomes of TAE for acute LGIB through a meta-analysis, thereby providing valuable evidence to inform clinical decision-making.

METHODS

A comprehensive search was conducted across PubMed, Embase, Web of Science, and Cochrane databases. Studies meeting predefined criteria were selected, and key clinical outcomes, including the technical success rate, clinical success rate, rebleeding rate, and complication rate of TAE in LGIB treatment, were extracted. A random-effects model was employed for data integration, and heterogeneity was assessed using the I2 statistic. The quality of the included studies was evaluated, and publication bias was examined using funnel plots and Egger's test. Subgroup analyses were performed based on the use of TAE as a first-line treatment, the type of embolic materials used, and the year of publication.

RESULTS

A total of 58 studies involving 2262 patients were included. The technical success rate of TAE was 97.7% (95% CI 96.4-98.9%); the clinical success rate was 75.0% (95% CI 71.3-78.6%); the rebleeding rate was 17.3% (95% CI 14.7-20.1%); the rate of major complications was 4.3% (95% CI 3.0-5.8%); the rate of mild ischemia was 4.7% (95% CI 2.9-6.7%); and the rate of secondary complications was 10.8% (95% CI 7.5-14.6%). Subgroup analysis revealed that, since 2010, both the efficacy and safety of TAE have improved, with a notable reduction in overall ischemic events (including both severe and mild intestinal ischemia) from 12.7% to 6.3%.

CONCLUSION

TAE is an effective and safe interventional treatment for acute LGIB, demonstrating high technical and clinical success rates. However, the occurrence of ischemia and complications continues to present significant challenges. Future advancements in technology are expected to further improve treatment outcomes.