Embolization as first-line therapy for diverticular massive lower gastrointestinal bleeding: Evidence from a meta-analysis

Abstract

Objective. To determine which etiologies of lower gastrointestinal bleeding (LGIB) may best be treated with super-selective embolization. Methods. A meta-analysis was undertaken of all 25 identified publications reporting the use of embolization and 12 consecutive cases of LGIB from the authors’ institution. Seven series met selection criteria for further analysis. Results. Multiple regression analysis demonstrated no significant difference in pooled outcomes when varying the included study, age, or embolization method on the outcome of rebleeding. The pooled odds ratio for rebleeding up to 30 days postlocalization and embolization for arteriovenous malformations (AVM) and other diseases was 3.53 compared to re-bleeding after localization and embolization for diverticular disease [95% Confidence Interval OR (1.33, 9.41), P < 0.01]. Embolization for diverticular bleeding demonstrated was successful in 85% of cases. Moreover, the vast majority of cases that rebled did so within 48 h. In contrast, rebleeding after embolization for nondiverticular bleeding occurred in greater than 40% of cases and over a more protracted period. Conclusion. Embolization for LGIB is most effective for the treatment of diverticular bleeding. Given the low observed complication rate, minimal post-procedure recovery time, and low failure rate, super-selective embolization may be considered first-line therapy for severe diverticular LGIB regardless of age. Caution should be used when applying embolization therapy for non-diverticular causes due to the considerably higher associated failure rate.