title: Embolization versus surgery for peptic ulcer bleeding after failed endoscopic hemostasis: a meta-analysis.
abstract: OBJECTIVE
  A meta-analysis was conducted to assess the efficacy of transcatheter arterial embolization (TAE) compared with surgery in the management of patients with recurrent nonvariceal upper gastrointestinal bleeding (NVUGIB) after failure of endoscopic hemostasis.
  
  
  METHODS
  Publications in English and non-English literatures (OVID, MEDLINE, and EMBASE) and abstracts from major international conferences were searched for studies comparing TAE with surgery for treatment of NVUGIB after endoscopic hemostasis failure. Outcome measures included rebleeding rate, all-cause mortality rate, and need for additional interventions to secure hemostasis.
  
  
  RESULTS
  From 1234 citations, 6 retrospective comparative studies were included that involved 423 patients (TAE, 182, 56 % male; surgery, 241, 68 % male). TAE patients were older (mean age, TAE 75, surgery, 68). The risk of rebleeding was significantly higher in TAE patients compared with surgically treated patients (relative risk [RR] 1.82, 95 % confidence interval [95 %CI] 1.23 - 2.67), with no statistically significant heterogeneity among the included studies (P = 0.66, I (2) = 0.0 %). After sensitivity analysis excluding studies with a large age difference between the two groups, a higher risk of bleeding remained in the TAE group (RR 2.64, 95 %CI] 1.48 - 4.71). No significant difference in mortality (RR 0.87, 95 %CI 0.59 - 1.29) or requirement for additional interventions (RR 1.67, 95 %CI 0.75 - 3.70) was shown between the two groups.
  
  
  CONCLUSIONS
  A higher rebleeding rate was observed after TAE, suggesting surgery more definitively secured hemostasis, with no significant difference in mortality rate or requirement of additional interventions. The TAE patients were older and in poorer health, thus future randomized studies are needed for accurate comparison of the two modalities.
authors.affiliation: Institute of Digestive Diseases, Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Moe
authors.initials: M
authors.lastname: Kyaw
authors.affiliation: Institute of Digestive Diseases, Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Yee
authors.initials: Y
authors.lastname: Tse
authors.affiliation: Department of Gastroenterology, Changi General Hospital, Singapore.
authors.forename: Daphne
authors.initials: D
authors.lastname: Ang
authors.affiliation: Department of Gastroenterology, Changi General Hospital, Singapore.
authors.forename: Tiing Leong
authors.initials: TL
authors.lastname: Ang
authors.affiliation: Institute of Digestive Diseases, Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: James
authors.initials: J
authors.lastname: Lau