恶性胆道阻塞患者的内镜缩膜切除和不切除胆道支架:随机对照试验的元分析
Aamir Saeed1, Saira Yousuf1, Muhammad Ali Khan2
1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
European journal of gastroenterology & hepatology
|February 7, 2025
概括
在ERCP期间用于恶性胆道阻塞的内镜胆道缩切除术 (EBS) 不会降低ERCP后胰腺炎的风险. 这种手术增加了出血并发症的可能性,但没有改善支架插入的成功.
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.
- 在瘤学瘤学.
背景情况:
- 内镜胆道透切除术 (EBS) 经常与内镜逆行胆道透切除术 (ERCP) 用于恶性胆道阻塞 (MBO).
- 关于EBS在接受ERCP的MBO患者的安全性和疗效存在相互矛盾的数据.
- 需要更新的元分析来澄清这些结果.
研究的目的:
- 评估EBS在接受ERCP的MBO患者的安全性和有效性.
- 确定EBS是否可以降低ERCP后胰腺炎 (PEP) 的风险.
- 在MBO的ERCP期间评估与EBS相关的其他不良事件.
主要方法:
- 截至2024年1月10日发布的随机对照试验 (RCT) 的更新元分析.
- 包括6个RCT与1070名患者,在MBO患者中比较ERCP与没有EBS的ERCP.
- 使用随机效应模型分析了包括PEP,支架插入成功,胆管炎,出血,穿孔,支架迁移和闭塞在内的结果.
主要成果:
- 两组之间PEP率没有显著差异 (RR0.50;95% CI:0.23-1.08).
- 在成功插入支架率上没有显著差异 (RR 1.01; 95% CI: 0.99-1.02).
- 在EBS组中,ERCP后出血率显著更高 (RR 7.43; 95% CI: 2.45-22.53).
- 结肠炎,穿孔,支架迁移或闭塞率没有显著差异.
结论:
- 在患有恶性胆道阻塞的患者中,内镜胆道膜切除并不会降低ERCP后胰腺炎的风险.
- 在MBO的ERCP期间,EBS与出血并发症的风险增加有关.
- 在这种情况下,EBS的常规使用需要仔细考虑,因为由于增加出血风险而没有被证明的胰腺炎益处.
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