用内镜超声波引导的胆管排水治疗急性胆管炎的第二次胆管阻塞:系统性审查和元分析
Yash Shah1, Sahib Singh2, Dushyant S Dahiya3
1Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI.
概括
在ERCP失败时,内超声引导胆管排水 (EUS-BD) 是急性胆炎的安全有效替代方案. 这一元分析显示,在这些具有挑战性的病例中,EUS-BD的成功率高,并发症可控.
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.
- 胆汁干预 胆汁干预
背景情况:
- 内镜逆行胆血管细胞造影 (ERCP) 是胆道阻塞的标准,但失败率为5-7%.
- 急性胆道炎具有显著的发病率和死亡率风险.
- 在ERCP失败时,内镜超声引导胆管排水 (EUS-BD) 是一种替代方案.
研究的目的:
- 评估EUS-BD在患有胆道阻塞后的急性胆道炎患者的安全性和有效性.
- 进行第一个元分析,对肠道炎患者的EUS-BD结果进行子组分析.
主要方法:
- 按照PRISMA指南进行系统审查和元分析.
- 搜索了主要的数据库 (MEDLINE,Embase,科学网等) 在2023年12月之前.
- 包括对成人患者进行EUS-BD治疗胆道炎的研究;评估了技术/临床成功,并发症和死亡率.
主要成果:
- 聚合的技术成功率为95.5% (95% CI: 91.0-98.5).
- 综合的临床成功率为92.1% (95% CI: 86.4-96.3).
- 综合并发症率为12.2% (95% CI:5.1-21.8),大多数是轻微的,自我限制的并发症.
结论:
- 在急性胆道炎患者中,EUS-BD表现出卓越的技术和临床成功.
- 当ERCP不可行时,它是一个可行的替代方案.
- EUS-BD提供了一个安全的管理选择,主要是轻微的并发症.
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