Effectiveness of endoscopic treatments for colonic diverticular bleeding
Effectiveness of endoscopic treatments for colonic diverticular bleeding
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DOI：
10.1016/j.gie.2017.08.013
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发表时间：
2018-01-01
影响因子：
7.7
通讯作者：
Kaise, Mitsuru
中科院分区：
文献类型：
--
作者：
Ishii, Naoki;Omata, Fumio;Kaise, Mitsuru
背景和目的：结肠憩室出血(CDB)的治疗有多种内窥镜方法。本研究的目的是评估内窥镜治疗CDB的有效性。方法：我们对英文文献进行了系统回顾和荟萃分析。主要结果是初始止血，早期复发出血(内窥镜治疗后30天内复发出血)，以及需要经导管动脉栓塞术(TAE)或手术。从每项研究中收集的比例被用来计算合并估计。结果：共纳入16项研究，384例CDB患者。最初止血的综合估计为：凝血，1.00(95%可信区间，0.91-1.00)(I-2=0.0%)；夹闭，0.99(95%可信区间，0.97-1.00)(I-2=0.0%)；结扎，0.99(95%可信区间，0.951.00)(I-2=0.0%)。早期复发出血的综合估计为：凝血，0.21(95%可信区间，0.01-0.51)(I-2=61.2%)；夹闭，0.19(95%可信区间，0.07-0.35)(I-2=77.3%)；结扎术，0.09(95%可信区间，0.04-0.15)(I-2=0.0%)。TAE或手术的综合估计为：凝血，0.18(95%可信区间，0.00-0.61)(I-2=68.9%)；夹闭，0.08(95%可信区间，0.03-0.16)(I-2=36.8%)；结扎，0.00%(95%可信区间，0.0001)(I-2=0.0%)。结扎组需要TAE或手术的比例明显低于夹闭组(P=.003)，略低于凝固组(P=.086)。结扎组与结扎组比较差异无统计学意义(P=.44)。结论：结扎组比结扎组更有效，避免了TAE或手术。在初始止血和防止早期复发出血方面，凝固术、夹闭术和结扎术的效果不明确。
Background and Aims: Several endoscopic modalities have been used for the treatment of colonic diverticular bleeding (CDB). The aim of this study was to evaluate the effectiveness of endoscopic treatment for CDB.Methods: We performed a systematic review and meta-analysis of the English literature. Main outcomes were initial hemostasis, early recurrent bleeding (recurrent bleeding within 30 days after endoscopic treatment), and need for transcatheter arterial embolization (TAE) or surgery. Proportions were collected from each study and were used to calculate pooled estimates. Heterogeneity was evaluated by I-2.Results: Sixteen studies (384 patients with CDB) were included. Pooled estimates of initial hemostasis were coagulation, 1.00 (95% CI,.91-1.00) (I-2 = .0%); clipping,.99 (95% CI,.97-1.00) (I-2 = .0%); and ligation,.99 (95% CI,.951.00) (I-2 = .0%). Pooled estimates of early recurrent bleeding were coagulation,.21(95% CI,.01-.51) (I-2 = 61.2%); clipping,.19 (95% CI,.07-.35) (I-2 = 77.3%); and ligation,.09 (95% CI,.04-.15) (I-2 = .0%). Pooled estimates of need for TAE or surgery were coagulation,.18 (95% CI,.00-.61) (I-2 = 68.9%); clipping,.08 (95% CI,.03-.16) (I-2 = 36.8%); and ligation,.00 (95% CI,.00-.01) (I-2 = .0%). The proportion of need for TAE or surgery in the ligation group was significantly lower than that in the clipping group (P = .003) and marginally lower than in the coagulation group (P = .086). No significant difference was found between coagulation and clipping groups (P = .44).Conclusions: Ligation therapy was more effective compared with clipping to avoid TAE or surgery. Coagulation, clipping, and ligation were equivocal in terms of effectiveness for initial hemostasis and preventing early recurrent bleeding.