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Peer-reviewedCC BY 4.0Frontiers in Medicine

Efficacy and safety of bronchial artery embolization in the treatment of hemoptysis:a systematic review and meta-analysis of RCTs

  • Minhui Zhang1,2
  • Junchen Wang3,4
  • Yunyun Shuai3,4
  • Rongxuan Zhang1,5
  • Xiaojuan Kou3,4
  • Fan Wang4
  • Zhaoxia Li3,4
  • Haihong Li1,2
5 affiliations
  1. 1School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
  2. 2Gansu Provincial Maternity and Child-care Hospital/Gansu Provincial Central Hospital, Lanzhou, Gansu, China
  3. 3The Second Hospital of Gansu Province, Lanzhou, Gansu, China
  4. 4School of Clinical Medicine, Northwest Minzu University, Lanzhou, Gansu, China
  5. 5The Second Hospital of Lanzhou, Lanzhou, Gansu, China
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Abstract

Background: Bronchial artery embolization (BAE) is widely used for hemoptysis, but the supporting evidence has mainly been derived from observational studies, and its certainty remains unclear. This study aimed to evaluate the efficacy and safety of BAE compared with other treatment modalities based exclusively on randomized controlled trials (RCTs), with evidence certainty assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Methods: We searched seven databases from inception to December 29, 2024, without language restrictions. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed, and evidence certainty was assessed using GRADE. Comparator-specific analyses were primary for the main outcomes, while pooled analyses across different comparators were exploratory. An updated search on June 24, 2026 identified no additional eligible RCTs. The review was registered in PROSPERO.

Result: Twenty RCTs involving 1,594 patients were included. Compared with pharmacotherapy, BAE showed higher clinical efficacy (RR 1.24, 95% CI 1.18–1.31), lower recurrence (RR 0.26, 95% CI 0.13–0.54), lower mortality (RR 0.20, 95% CI 0.05–0.90), and fewer overall complications (RR 0.41, 95% CI 0.26–0.63), all supported by moderate-certainty evidence. BAE plus usual care versus usual care showed higher clinical efficacy (RR 1.27, 95% CI 1.12–1.43; very-low-certainty evidence) and lower recurrence (RR 0.28, 95% CI 0.15–0.53; moderate-certainty evidence), but no clear differences in mortality (RR 0.36, 95% CI 0.05–2.43) or overall complications (RR 1.04, 95% CI 0.45–2.39), both with low-certainty evidence. Compared with bronchoscopic balloon tamponade, BAE showed no clear difference in clinical efficacy (RR 0.91, 95% CI 0.80–1.03; low-certainty evidence), recurrence (RR 2.14, 95% CI 0.17–27.10; very-low-certainty evidence), or overall complications (RR 1.15, 95% CI 0.54–2.46; low-certainty evidence).

Conclusions: The comparative effects of BAE varied by treatment strategy. Evidence was more consistent versus pharmacotherapy, while estimates for bronchoscopic balloon tamponade and add-on usual-care designs were less certain. Findings should therefore be interpreted by specific treatment contrast rather than as a single overall effect. Further well-designed multicenter RCTs are needed.

Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO identifier CRD420250643812.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026efficacy,
  title = {{Efficacy and safety of bronchial artery embolization in the treatment of hemoptysis:a systematic review and meta-analysis of RCTs}},
  author = {Minhui Zhang and Junchen Wang and Yunyun Shuai and Rongxuan Zhang and Xiaojuan Kou and Fan Wang and Zhaoxia Li and Haihong Li},
  journal = {Frontiers in Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fmed.2026.1959450},
  url = {https://doi.org/10.3389/fmed.2026.1959450},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Efficacy and safety of bronchial artery embolization in the treatment of hemoptysis:a systematic review and meta-analysis of RCTs
AU  - Minhui Zhang
AU  - Junchen Wang
AU  - Yunyun Shuai
AU  - Rongxuan Zhang
AU  - Xiaojuan Kou
AU  - Fan Wang
AU  - Zhaoxia Li
AU  - Haihong Li
PY  - 2026
DA  - 2026/10/21
JO  - Frontiers in Medicine
DO  - 10.3389/fmed.2026.1959450
UR  - https://doi.org/10.3389/fmed.2026.1959450
AB  - Background: Bronchial artery embolization (BAE) is widely used for hemoptysis, but the supporting evidence has mainly been derived from observational studies, and its certainty remains unclear. This study aimed to evaluate the efficacy and safety of BAE compared with other treatment modalities based exclusively on randomized controlled trials (RCTs), with evidence certainty assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.  Methods: We searched seven databases from inception to December 29, 2024, without language restrictions. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed, and evidence certainty was assessed using GRADE. Comparator-specific analyses were primary for the main outcomes, while pooled analyses across different comparators were exploratory. An updated search on June 24, 2026 identified no additional eligible RCTs. The review was registered in PROSPERO.  Result: Twenty RCTs involving 1,594 patients were included. Compared with pharmacotherapy, BAE showed higher clinical efficacy (RR 1.24, 95% CI 1.18–1.31), lower recurrence (RR 0.26, 95% CI 0.13–0.54), lower mortality (RR 0.20, 95% CI 0.05–0.90), and fewer overall complications (RR 0.41, 95% CI 0.26–0.63), all supported by moderate-certainty evidence. BAE plus usual care versus usual care showed higher clinical efficacy (RR 1.27, 95% CI 1.12–1.43; very-low-certainty evidence) and lower recurrence (RR 0.28, 95% CI 0.15–0.53; moderate-certainty evidence), but no clear differences in mortality (RR 0.36, 95% CI 0.05–2.43) or overall complications (RR 1.04, 95% CI 0.45–2.39), both with low-certainty evidence. Compared with bronchoscopic balloon tamponade, BAE showed no clear difference in clinical efficacy (RR 0.91, 95% CI 0.80–1.03; low-certainty evidence), recurrence (RR 2.14, 95% CI 0.17–27.10; very-low-certainty evidence), or overall complications (RR 1.15, 95% CI 0.54–2.46; low-certainty evidence).  Conclusions: The comparative effects of BAE varied by treatment strategy. Evidence was more consistent versus pharmacotherapy, while estimates for bronchoscopic balloon tamponade and add-on usual-care designs were less certain. Findings should therefore be interpreted by specific treatment contrast rather than as a single overall effect. Further well-designed multicenter RCTs are needed.  Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO identifier CRD420250643812.
SN  - 2296-858X
ER  -