Rollhauser C, Fleischer D E
Hospital Privado, Catholic University School of Medicine, Cordoba, Cordoba, Argentina.
Baillieres Best Pract Res Clin Gastroenterol. 2000 Jun;14(3):391-410. doi: 10.1053/bega.2000.0086.
This article provides an overview of the therapeutic endoscopic modalities available for the treatment of peptic ulcer bleeding. The benefits of endoscopic haemostasis have been fully demonstrated by three meta-analyses, which included most of the controlled trials published until 1992. In this review, an emphasis is placed on randomized, prospective comparative trials published during the past 20 years. Using an evidence-based medicine approach, the results of meta-analyses are translated into efficacy measures known as relative and absolute risk reductions, and number needed to treat. Single-modality treatments with injection agents such as epinephrine, sclerosants and thrombogenic substances, or with thermal therapies, are efficacious and comparable. Combination therapy involving injection and thermal techniques may offer an advantage over single-method therapy. The differences in the results between clinical trials and routine clinical practice, and among the various randomized studies, are probably related to operators' experience and variations in technique rather than to inconsistency of endoscopic haemostasis.
本文概述了可用于治疗消化性溃疡出血的内镜治疗方法。三项荟萃分析充分证明了内镜止血的益处，这些分析纳入了截至1992年发表的大多数对照试验。在本综述中，重点关注过去20年发表的随机、前瞻性比较试验。采用循证医学方法，将荟萃分析的结果转化为称为相对和绝对风险降低以及治疗所需人数的疗效指标。使用肾上腺素、硬化剂和促凝血物质等注射剂或热疗法进行的单模式治疗是有效的且具有可比性。涉及注射和热技术的联合治疗可能比单一方法治疗更具优势。临床试验与常规临床实践之间以及各种随机研究之间结果的差异，可能与操作者的经验和技术差异有关，而非内镜止血的不一致性。
