Endoscopic hemostasis combined with vascular interventional therapy for acute nonvariceal upper gastrointestinal bleeding - A meta-analysis

Q: What problem does this meta-analysis address in NVUGIB treatment?

It compares the clinical outcomes and safety of combining endoscopic hemostasis with vascular interventional therapy versus standard therapy for acute nonvariceal upper gastrointestinal bleeding.

Q: How were studies searched and how was study quality assessed?

The analysis searched PubMed, EMBASE, Cochrane Library, and Web of Science up to April 2025. RCT quality was assessed using Cochrane RoB 2.0, observational studies with the Critical Appraisal Skills Program, and quantitative synthesis used RevMan 5.4 with fixed/random-effects based on I².

Q: What were the main efficacy and safety findings?

Combined therapy significantly reduced rebleeding, while showing no difference in mortality compared with standard therapy. Age and vascular interventional methods may influence therapeutic efficacy.

Sep 28, 2026

Uploaded by Ben

Acute nonvariceal upper gastrointestinal bleeding (NVUGIB) is a life-threatening emergency in gastroenterology. Endoscopic hemostasis and vascular interventional therapy are widely used minimally invasive strategies, yet their comparative efficacy and safety remain controversial across patient populations and anatomical sites. This meta-analysis evaluates combined endoscopic hemostasis plus vascular interventional therapy versus standard therapy for clinical outcomes and safety in NVUGIB, using systematic searches and prespecified quantitative synthesis to assess effectiveness and rebleeding risk.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Abstract

Background

Aim

Methods

Results

Conclusion

Introduction

Clinical context and rationale

| W | J | G | S | World Journal of
Gastrointestinal Surgery | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastrointest Surg 2025 December 27; 17(12): 111268 DOI: 10.4240/wjgs.v17.i12.111268 ISSN 1948-9366 (online) META-ANALYSIS Endoscopic hemostasis combined with vascular interventional therapy for acute nonvariceal upper gastrointestinal bleeding: A meta-analysis Cun-Jin Zhou, Hui Sun, Xiao-He Tang Specialty type: Gastroenterology and hepatology Provenance and peer review: Unsolicited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade B Novelty: Grade C Creativity or Innovation: Grade B Scientific Significance: Grade C P-Reviewer: Yoon JE, Chief Physician, South Korea Received: August 1, 2025 Revised: September 10, 2025 Accepted: October 17, 2025 Published online: December 27, 2025 Processing time: 145 Days and 23.7 Hours Cun-Jin Zhou, Hui Sun, Xiao-He Tang, Department of Gastroenterology, The First Hospital of Zibo, Zibo 255200, Shandong Province, China Co-first authors: Cun-Jin Zhou and Hui Sun. Corresponding author: Xiao-He Tang, Department of Gastroenterology, The First Hospital of Zibo, No. 4 Emeishan East Alley, Boshan, Zibo 255200, Shandong Province, China. [xiaohe_tang2025@163.com](xiaohe_tang2025@163.com) Abstract BACKGROUND Acute nonvariceal upper gastrointestinal bleeding (NVUGIB) is a life-threatening emergency. Endoscopic hemostasis and vascular interventional therapy are two major minimally invasive treatment strategies. Although these modalities are widely used, their comparative efficacy and safety across different patient populations and anatomical sites remain controversial. AIM To evaluate the clinical outcomes and safety of endoscopic hemostasis combined with vascular interventional therapy for NVUGIB. METHODS A systematic search was done on PubMed, EMBASE, Cochrane Library, and Web of Science (from database establishment to April 2025) . Randomized controlled trial (RCT) quality was assessed via Cochrane RoB 2.0, and observational studies via the Critical Appraisal Skills Program. RevMan 5.4 was used for quantitative analysis; fixed/random-effects models were chosen through I²-assessed heterogeneity. Publication bias was checked using funnel plots and sensitivity analysis via model switching. RESULTS Twenty-one studies (3 RCTs, 12 single-group studies, and 6 retrospective cohort studies) with good quality were included. For single-group data, combined therapy had risk differences of 0.70 (clinical success), 0.24 (mortality), and 0.22 (rebleeding; all P < 0.00001, I² = 0) . Moreover, the ≥ 60-year rebleeding risk difference was 0.43. Reintervention was found to differ by approach (Z = 3.03, P = 0.002, inter-subgroup I² = 99%) . In the RCT and cohort studies, combined vs WJGS [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 27, 2025 Volume 17 Issue 12 Zhou CJ et al. Acute nonvariceal upper gastrointestinal bleeding standard therapy had similar initial hemostasis (Z = 0.04, P = 0.97) and mortality (Z = 1.56, P = 0.12) but lower rebleeding (Z = 3.26/P = 0.001; Z = 2.95/P = 0.03) . Symmetrical funnel plots and robust sensitivity analysis showed no publication bias. CONCLUSION Combined endoscopic hemostasis and vascular interventional therapy for acute NVUGIB can significantly reduce rebleeding, without differences in mortality. Age and vascular interventional methods may influence the therapeutic efficacy. Key Words: Endoscopic hemostasis; Vascular intervention; Acute; Nonvariceal; Upper gastrointestinal bleeding; Rebleeding; Clinical outcomes ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. Core Tip: This meta-analysis demonstrates that combining endoscopic hemostasis with vascular interventional therapy is effective for

FAQs

What problem does this meta-analysis address in NVUGIB treatment?

It compares the clinical outcomes and safety of combining endoscopic hemostasis with vascular interventional therapy versus standard therapy for acute nonvariceal upper gastrointestinal bleeding.

How were studies searched and how was study quality assessed?

The analysis searched PubMed, EMBASE, Cochrane Library, and Web of Science up to April 2025. RCT quality was assessed using Cochrane RoB 2.0, observational studies with the Critical Appraisal Skills Program, and quantitative synthesis used RevMan 5.4 with fixed/random-effects based on I².

What were the main efficacy and safety findings?

Combined therapy significantly reduced rebleeding, while showing no difference in mortality compared with standard therapy. Age and vascular interventional methods may influence therapeutic efficacy.

Sep 28, 2026

Uploaded by Ben