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

Amit Khanna, Steven J. Ognibene, Leonidas Koniaris

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

The study goal was to determine which etiologies of lower gastrointestinal bleeding (LGIB) may best be treated with superselective embolization. A meta-analysis was undertaken of 25 identified publications reporting the use of embolization and an unpublished series of 12 consecutive patients with LGIB from the authors' institution. Six published series and the authors' series met selection criteria for further analysis. 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 arteriovenous dysplastic lesions and other diseases was 3.53 compared with rebleeding after localization and embolization for diverticular disease (95% confidence interval odds ratio, 1.33, 9.41; P <0.01]. Embolization for diverticular bleeding was successful in 85% of patients. In contrast, rebleeding after embolization for nondiverticular bleeding occurred in greater than 40% of patients and over a more protracted period. Embolization for LGIB is most effective for the treatment of diverticular bleeding. Caution should be used when applying embolization therapy for nondiverticular causes due to the considerably higher associated failure rate. An inpatient observation period of 2 days is suggested following embolization for diverticular bleeding.

Original languageEnglish (US)
Pages (from-to)343-352
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume9
Issue number3
DOIs
StatePublished - Mar 1 2005
Externally publishedYes

Fingerprint

Diverticulum
Meta-Analysis
Hemorrhage
Therapeutics
Odds Ratio
Patient Selection
Publications
Inpatients
Regression Analysis
Observation
Confidence Intervals

Keywords

  • Arteriovenous abnormality
  • Colon
  • Diverticulosis
  • Lower gastrointestinal bleeding

ASJC Scopus subject areas

  • Surgery

Cite this

Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding : Evidence from a meta-analysis. / Khanna, Amit; Ognibene, Steven J.; Koniaris, Leonidas.

In: Journal of Gastrointestinal Surgery, Vol. 9, No. 3, 01.03.2005, p. 343-352.

Research output: Contribution to journalArticle

@article{5b0f39836eb74c64bf748e880d33607e,
title = "Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding: Evidence from a meta-analysis",
abstract = "The study goal was to determine which etiologies of lower gastrointestinal bleeding (LGIB) may best be treated with superselective embolization. A meta-analysis was undertaken of 25 identified publications reporting the use of embolization and an unpublished series of 12 consecutive patients with LGIB from the authors' institution. Six published series and the authors' series met selection criteria for further analysis. 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 arteriovenous dysplastic lesions and other diseases was 3.53 compared with rebleeding after localization and embolization for diverticular disease (95{\%} confidence interval odds ratio, 1.33, 9.41; P <0.01]. Embolization for diverticular bleeding was successful in 85{\%} of patients. In contrast, rebleeding after embolization for nondiverticular bleeding occurred in greater than 40{\%} of patients and over a more protracted period. Embolization for LGIB is most effective for the treatment of diverticular bleeding. Caution should be used when applying embolization therapy for nondiverticular causes due to the considerably higher associated failure rate. An inpatient observation period of 2 days is suggested following embolization for diverticular bleeding.",
keywords = "Arteriovenous abnormality, Colon, Diverticulosis, Lower gastrointestinal bleeding",
author = "Amit Khanna and Ognibene, {Steven J.} and Leonidas Koniaris",
year = "2005",
month = "3",
day = "1",
doi = "10.1016/j.gassur.2004.09.039",
language = "English (US)",
volume = "9",
pages = "343--352",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding

T2 - Evidence from a meta-analysis

AU - Khanna, Amit

AU - Ognibene, Steven J.

AU - Koniaris, Leonidas

PY - 2005/3/1

Y1 - 2005/3/1

N2 - The study goal was to determine which etiologies of lower gastrointestinal bleeding (LGIB) may best be treated with superselective embolization. A meta-analysis was undertaken of 25 identified publications reporting the use of embolization and an unpublished series of 12 consecutive patients with LGIB from the authors' institution. Six published series and the authors' series met selection criteria for further analysis. 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 arteriovenous dysplastic lesions and other diseases was 3.53 compared with rebleeding after localization and embolization for diverticular disease (95% confidence interval odds ratio, 1.33, 9.41; P <0.01]. Embolization for diverticular bleeding was successful in 85% of patients. In contrast, rebleeding after embolization for nondiverticular bleeding occurred in greater than 40% of patients and over a more protracted period. Embolization for LGIB is most effective for the treatment of diverticular bleeding. Caution should be used when applying embolization therapy for nondiverticular causes due to the considerably higher associated failure rate. An inpatient observation period of 2 days is suggested following embolization for diverticular bleeding.

AB - The study goal was to determine which etiologies of lower gastrointestinal bleeding (LGIB) may best be treated with superselective embolization. A meta-analysis was undertaken of 25 identified publications reporting the use of embolization and an unpublished series of 12 consecutive patients with LGIB from the authors' institution. Six published series and the authors' series met selection criteria for further analysis. 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 arteriovenous dysplastic lesions and other diseases was 3.53 compared with rebleeding after localization and embolization for diverticular disease (95% confidence interval odds ratio, 1.33, 9.41; P <0.01]. Embolization for diverticular bleeding was successful in 85% of patients. In contrast, rebleeding after embolization for nondiverticular bleeding occurred in greater than 40% of patients and over a more protracted period. Embolization for LGIB is most effective for the treatment of diverticular bleeding. Caution should be used when applying embolization therapy for nondiverticular causes due to the considerably higher associated failure rate. An inpatient observation period of 2 days is suggested following embolization for diverticular bleeding.

KW - Arteriovenous abnormality

KW - Colon

KW - Diverticulosis

KW - Lower gastrointestinal bleeding

UR - http://www.scopus.com/inward/record.url?scp=14744278586&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=14744278586&partnerID=8YFLogxK

U2 - 10.1016/j.gassur.2004.09.039

DO - 10.1016/j.gassur.2004.09.039

M3 - Article

C2 - 15749594

AN - SCOPUS:14744278586

VL - 9

SP - 343

EP - 352

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

IS - 3

ER -