Efficacy of local absolute ethanol injection for the management of ectopic pregnancy: a systematic review and meta-analysis

Abstract Background Current medical and surgical treatments for ectopic pregnancy are associated with significant adverse effects, highlighting the need for safer alternatives. This systematic review and meta-analysis evaluate the efficacy of ultrasonography-guided local absolute ethanol injection into trophoblastic tissue for managing ectopic pregnancy at various sites, including tubal, cervical, interstitial, cesarean scar, and peritoneal locations. Methods A systematic search was conducted in PubMed, Scopus, Embase, Web of Science, and Cochrane Library on January 16, 2024. The primary outcome was treatment success, defined as declining beta-human chorionic gonadotropin levels, while ectopic pregnancy resolution time was the duration from ethanol injection to beta-human chorionic gonadotropin reaching the negative level for pregnancy (< 5 mIU/mL). Study quality was evaluated using the Joanna Briggs Institute (JBI) Clinical Appraisal Tools. Using STATA 18, we conducted a random-effects meta-analysis to determine pooled success rates and compare them with laparoscopic surgery. Results Six retrospective studies encompassing a total of 432 patients were included, with all meeting quality thresholds on JBI appraisal. The ectopic pregnancy site distribution was as follows: tubal ( n = 3), cervical ( n = 3), interstitial ( n = 3), cesarean scar ( n = 3), and peritoneal ( n = 1). Mean baseline beta-human chorionic gonadotropin levels ranged from 1641.9 to 35,640.0 mIU/mL, with four studies including cases of fetal cardiac activity. The procedure’s success rate varied between 84 and 100%, with a pooled estimate of 93.3% (95% CI 89.1–97.6%; p -value < 0.001; I 2 = 66.7%). Only one study reported self-resolving peritoneal irritation; no other complications were documented. Furthermore, only one study compared ethanol injection versus laparoscopic surgery, demonstrating lower success rates in our meta-analysis (log odds ratio = − 1.803 [95% CI − 3.382, − 0.224]; p -value = 0.025). Conclusions Local absolute ethanol injection to the trophoblastic tissue appears to be a potentially effective treatment for ectopic pregnancy, demonstrating high success rates and minimal side effects. However, the limited number of studies, small sample sizes, and heterogeneity necessitate further large-scale comparative trials for validation. Protocol registration The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 10/4/2024 under the registration code CRD42024530622.