Tract Sealing Techniques for Pneumothorax and Drainage Prevention After CT-Guided Lung Biopsy: A Systematic Review and Meta-Analysis

Background/Objectives: Our goal was to evaluate the effectiveness of tract sealing agents in reducing pneumothorax and chest drainage insertion following CT-guided lung biopsy (CLB), and to assess the certainty of supporting evidence. Methods: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines (PROSPERO: CRD42024608747). Four health science databases (ScienceDirect, PubMed, Scopus, and Cochrane Library) were searched up to 13 October 2025. Randomized controlled trials and cohort studies reporting tract sealing after CLB were included. Outcomes were post-procedural pneumothorax and pleural drainage insertion. Both were analyzed as dichotomous variables using random-effects meta-analysis with the Mantel–Haenszel method. Statistical heterogeneity was assessed using the I2 statistic. Results were considered statistically significant for p < 0.05. Study quality was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk Of Bias In Non-randomized Studies—of Interventions, Version 2 (ROBINS-I V2) tool for cohort studies. Results: A total of 3328 records were initially retrieved, with 37 studies (13,107 patients, 7161 male and 4526 female) meeting the inclusion criteria. Sealing agents included saline solution, hydrogel plug, gelatin sponge, autologous blood patch, saline + rapid roll-over, hemocoagulase, gelatin sponge + hemocoagulase, and fibrin glue. Meta-analysis demonstrated significant reductions in pneumothorax and drainage insertion with saline solution (pneumothorax: OR = 0.35; 95% CI 0.25–0.48; p < 0.00001; drainage: OR = 0.22, 95% CI 0.11–0.43; p < 0.00001), gelatin sponge (pneumothorax: OR = 0.44, 95% CI 0.37–0.53; p < 0.00001; drainage: OR = 0.40, 95% CI 0.29–0.54; p < 0.00001), autologous blood patch (pneumothorax: OR = 0.50, 95% CI 0.40–0.62; p < 0.00001; drainage: OR = 0.40, 95% CI 0.27–0.59; p < 0.00001), and hydrogel plug (pneumothorax: OR = 0.65, 95% CI 0.50–0.85; p = 0.001; drainage: OR = 0.44, 95% CI 0.25–0.76; p < 0.004). Conclusions: Saline solution, hydrogel plug, gelatin sponge, and autologous blood patch are sealing agents that are effective at lowering the risk of pneumothorax and drainage insertion following CLB.