在急性耐火性水出血中的食道支架:系统性审查和元分析
Busara Songtanin1, Chanaka Kahathuduwa1, Kenneth Nugent1
1Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
自扩展金属支架 (SEMS) 提供了高的立即出血控制率,用于耐火性食道水出血. 在其他治疗方法失败之前,SEMS作为关键的桥梁疗法,在最终干预之前.
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.
- 肝病学 肝病学是一种肝病学.
背景情况:
- 急性食道水出血是肝硬化患者的严重并发症,耐火病例带来危及生命的风险.
- 传统疗法,如气球吸管有局限性,以及先进的选择,如TIPS或肝移植不是普遍可用的.
- 自扩展金属支架 (SEMS) 已成为耐火性水出血的潜在管理策略.
研究的目的:
- 评估使用SEMS在治疗耐性食道变形出血患者中的有效性和安全性.
- 通过对相关研究的元分析来综合现有证据.
主要方法:
- 在MEDLINE,EMBASE和Cochrane图书馆数据库中进行了系统的文献搜索,直到2022年10月.
- 包括的研究涉及18岁以上的患者,至少有10名参与者,重点是食道支架治疗水出血.
- 使用R统计软件进行了DerSimonian-Laird随机效应元分析.
主要成果:
- 分析包括12项涉及225名患者的研究,使用228种SEMS.
- 在91%的病例中,立即控制出血,再出血率为17%.
- 不良事件包括支架 (7%) 和迁移 (18%),所有原因的整体死亡率为38%.
结论:
- SEMS在控制急性难治性食道水出血方面表现出显著的有效性.
- 在内镜带绑定和硬化疗法失败后,SEMS被推作为救援疗法.
- SEMS可以作为一座至关重要的桥梁,通向更为明确的治疗方法,如TIPS或肝移植.
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