二次观察内镜在内镜下粘膜切割和胃潰瘍出血中的作用:随机对照试验的元分析
Gowthami Sai Kogilathota Jagirdhar1, Jose Andres Perez2, Akshat Banga3
1Department of Medicine, Saint Francis Health Science Center, Newark, NJ 07107, United States.
二次视野内镜 (SLE) 并不能防止在内镜下粘膜解剖 (ESD) 或胃潰瘍疾病 (PUD) 后再次出血. 虽然SLE可能会减少PUD患者的住院时间,但它对死亡率或输血需求没有显著的好处.
科学领域:
- 胃肠病学 胃肠病学
- 内镜检查是指内镜检查.
- 胃肠道手术 胃肠道手术
背景情况:
- 二次视野内镜 (SLE) 通常用于预防患有胃潰瘍疾病 (PUD) 的患者和内镜下层剖析 (ESD) 后的复发出血.
- 关于SLE疗效,风险,益处和成本效益的现有证据是相互矛盾的.
研究的目的:
- 评估SLE在ESD和PUD患者中的作用和有效性.
- 评估SLE对再出血率,死亡率,住院时间以及干预和输血的需要的影响.
主要方法:
- 从PubMed,Cochrane和Embase (直到2023年1月) 进行随机对照试验的系统审查和元分析.
- 研究将SLE与没有SLE进行比较,或在SLE期间评估预防性血液静止与保守干预.
- 遵循PRISMA指南,并使用RevMan与随机效应模型分析数据.
主要成果:
- 包括12项研究,涉及2687名患者 (1074名ESD后,1613名PUD后出血).
- 在SLE和非SLE组之间,没有观察到ESD (7%对4.4%,P=0.07) 或PUD (11%对13%,P=0.36) 的重出血率有显著差异.
- 在PUD患者中,SLE没有显著影响死亡率,干预措施或输血,但显示了减少内镜干预的趋势 (OR 0.29,P=0.05).
结论:
- 二次视野内镜 (SLE) 不能有效地防止ESD或PUD后的患者再次出血.
- 在PUD患者中,SLE并不能显著改善死亡率,干预率或输血需求.
- 在PUD患者中,SLE与住院时间缩短约3.5天有关.
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