背景:急性非静脉曲张性上消化道出血(ANVUGIB)是胃肠病学中常见的危及生命的急性疾病,发病率和死亡率高。过镜夹(OTSC)是一种新的内镜止血技术,正在ANVUGIB中使用并且更有效。
目的:总结分析OTSC预防再出血的效果。临床成功率,程序时间,住院,ANVUGIB治疗中的不良事件,评估OTSC是否可以替代标准内镜治疗作为ANVUGIB的新一代治疗方法。
方法:在PubMed中搜索了2023年1月之前发表的与OTSC和ANVUGIB标准疗法相关的文献,WebofScience,EMBASE,科克伦,Google,和CNKI数据库。复发性出血的变化(7或30天),临床结果(临床成功率,手术转化率,死亡率),治疗时间(手术时间,住院时间),对OTSC干预组的不良事件进行总结和分析,95CI的MD或OR由ReviewManager5.3计算。
结果:这项荟萃分析涉及11项研究,包括1266名患者。偏倚的总风险为中高。对于OTSC组的患者,7天和30天复发性出血率,以及程序时间,住院,和重症监护室停留,被大大抑制了。OTSC可以显著提高ANVUGIB的临床成功率。OTSC治疗未引起严重不良反应,可有效降低患者死亡率。
结论:OTSC可以提供更快速和持续的止血,因此,促进ANVUGIB患者的康复并降低死亡率。此外,保证了OTSC的安全性。
BACKGROUND: Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is a frequent life-threatening acute condition in gastroenterology associated with high morbidity and mortality. Over-the-scope-clip (OTSC) is a new endoscopic hemostasis technique, which is being used in ANVUGIB and is more effective.
OBJECTIVE: To summarize and analyze the effects of the OTSC in prevention of recurrent bleeding, clinical success rate, procedure time, hospital stay, and adverse events in the treatment of ANVUGIB, to evaluate whether OTSC can replace standard endoscopic therapy as a new generation of treatment for ANVUGIB.
METHODS: The literature related to OTSC and standard therapy for ANVUGIB published before January 2023 was searched in PubMed, Web of Science, EMBASE, Cochrane, Google, and CNKI databases. Changes in recurrent bleeding (7 or 30 days), clinical results (clinical success rate, conversion rate to surgery, mortality), therapy time (procedure time, hospital stay), and adverse events in the OTSC intervention group were summarized and analyzed, and the MD or OR of 95%CI is calculated by Review Manager 5.3.
RESULTS: This meta-analysis involved 11 studies with 1266 patients. Total risk of bias was moderate-to-high. For patients in the OTSC group, 7- and 30-days recurrent bleeding rates, as well as procedure time, hospital stay, and intensive care unit stay, were greatly inhibited. OTSC could significantly improve the clinical success rate of ANVUGIB. OTSC therapy did not cause serious adverse and was effective in reducing patient mortality.
CONCLUSIONS: OTSC may provide more rapid and sustained hemostasis, and thus, promote recovery and reduce mortality in patients with ANVUGIB. In addition, the safety of OTSC is assured.