Prophylactic transarterial embolization after endoscopic hemostasis in patients with non-variceal upper gastrointestinal bleeding - is it time to act?

Background Non-variceal upper gastrointestinal bleeding (NVUGIB) continues to present a significant clinical burden due to rebleeding after apparently successful endoscopic hemostasis, particularly in ulcers overlying large-caliber arterial territories. Prophylactic transarterial embolization (pTAE) has been proposed as a strategy to prevent rebleeding in high-risk patients. This mini-review evaluates the evidence for pTAE after successful endoscopic control in NVUGIB, focusing on patient selection, technical approaches, outcomes, and complications. Methods A literature search of PubMed and Scopus (January 2010–September 2025) was conducted, yielding 10 studies (two randomized trials, three prospective, and five retrospective) evaluating pTAE. Only studies addressing prophylactic, not empiric, embolization were included. Results Evidence suggests that pTAE is technically feasible and generally safe when guided by ulcer location, size (≥15–20 mm), Rockall score (≥5), and arterial territory (GDA or LGA). While randomized trials did not show overall superiority in intention-to-treat analyses, per-protocol data and observational studies suggest reduced rebleeding and a lower need for surgical rescue in well-selected patients. Complications are infrequent when standardized techniques and early timing (≤24 h) are applied. Conclusion Routine pTAE is not supported by current guidelines or RCT-level evidence. However, in anatomically and clinically high-risk ulcers, pTAE may offer meaningful benefits. Further multicenter randomized trials with uniform protocols are warranted to clarify its role and optimize patient selection.