結腸ボルブルス閉塞における内視鏡性脱皮の安全性と有効性:体系的なレビューとメタ解析
Filippo Sabatini1, Luca Properzi1, Gabriele Marinozzi2
1Dipartimento di Chirurgia Generale e Digestiva, Università degli Studi di Perugia, Ospedale "Santa Maria", 05100 Terni, Italy.
Journal of clinical medicine
|February 13, 2026
まとめ
エンドスコピック変形 (ED) はシグモイド・ヴォルブルスを効果的に解圧するが,再発率は高い. 結果を標準化し,この重大な状態の患者の管理経路を改善するためにさらなる研究が必要である.
科学分野:
- 胃腸内科 胃腸内科
- 結腸直腸外科手術について
- 医療介入 医療介入について
背景:
- シグモイド・ボルブルスは,大腸閉塞の重要な原因である.
- 内視歪曲 (ED) は,急速な解圧と粘膜活性の評価のための主要な介入です.
- 既存の文献は,EDの成功率,再発率,死亡率の変動を示しており,証拠に基づいた決定を妨げています.
研究 の 目的:
- シグモイド変形 (sigmoid volvulus) のための内視鏡変形 (ED) の有効性およびアウトカムを体系的にレビューし,メタ分析する.
- 技術的な成功率,再発率,およびEDに関連する死亡率を定量化する.
- 報告されたアウトカムにおける異質性に寄与する要因を特定する.
主な方法:
- PRISMAのガイドラインに従って,体系的なレビューとメタ分析を行いました.
- MEDLINE/PubMedとEmbaseのデータベースを,設立から2025年10月まで検索した.
- ランダム効果モデルを用いたシグモイド・ヴォルブルスのED後のアウトカムを報告した19件の研究 (n=1738-3285) を含めた.
主要な成果:
- 統合されたEDの技術的な成功率は80.0% (95%CI: 75.0-83.0%) でした.
- 成功したED後の再発率は33.9% (95%CI:19.5-52.1%) でした.
- 集団死亡率の推定値は22.6% (95%CI:18.7-26.4%) であり,異質性が高い (I2 > 87%).
結論:
- エンドスコピーによる歪曲は,合併症のないシグモイド・ヴォルブルスの初期介入として有効です.
- 高い再発率と有意な結果の異質性は,構造化された臨床経路を必要とします.
- 標準化された粘膜の評価と,最終的な管理のための適時な計画が,ED後の決定的に重要です.
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