在没有在对比度增强计算机断层扫描上外流的结肠分支出血的情况下,紧急结肠镜检查不必要
Tomoya Sugiyama1, Yuki Kojima2, Yoshikazu Hirata2
1Department of Gastroenterology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan.
概括
紧急结肠镜检查 (UCS) 对于没有CT扫描外流的结肠分管出血 (CDB) 患者是不必要的. 这项研究发现,在接受UCS和接受保守管理的患者之间,再出血率或临床结果没有显著差异.
科学领域:
- 胃肠病学 胃肠病学
- 干预性内镜检查是干预性的内镜检查.
- 放射学 放射学是一门学科.
背景情况:
- 急性下胃肠道出血 (ALGIB) 是常见的,特别是在老年人和接受抗血小板治疗的人群中.
- 结肠分管出血 (CDB) 是ALGIB的主要原因,通常通过内镜血静控制.
- 在CDB患者中,紧急结肠镜 (UCS) 在没有对比增强计算机断层扫描 (CECT) 上外流的实用性仍然在临床结果方面进行辩论.
研究的目的:
- 评估紧急结肠镜 (UCS) 在管理结肠分支出血 (CDB) 患者的有效性,没有证据表明CECT.
- 确定UCS是否改善了该特定患者群体的临床结果,包括复出血率和住院时间.
主要方法:
- 在2014年7月至2019年7月期间接受CECT治疗的282名CDB患者的回顾性研究.
- 进行UCS的74名患者和保守管理的208名患者 (非UCS) 之间的临床结果比较.
- 分析非常早期 (5天内) 和早期 (6-30天) 再出血,输血需求和住院时间.
主要成果:
- 在UCS和非UCS组之间的非常早期再出血率中没有发现显著差异.
- 临床过程因素,包括再出血率,输血需求和住院时间,在UCS和非UCS组之间没有显著差异.
- 紧急结肠镜检查并没有改善CDB患者的复出率或整体临床过程,而不是在CECT上扩散.
结论:
- 紧急结肠镜检查在CECT没有显示出外流时,对于结肠分管出血患者来说不是必要的干预措施.
- 保守的管理似乎是一个可行的策略,对于CDB患者没有CECT的扩散,避免潜在的风险和不必要的程序的成本.
- 进一步的研究可能会根据成像发现和患者特定因素完善ALGIB的管理策略.
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