Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, China.
J Gastroenterol Hepatol. 2010 Jan;25(1):8-13. doi: 10.1111/j.1440-1746.2009.06129.x.
In the management of peptic ulcer bleeding, the benefits of second-look endoscopic treatment with thermal coagulation or injections in controlling recurrent bleeding is unsure. This study set out to compare efficacy of routine second-look endoscopy with treatment using either thermal coagulation or injections versus single endoscopy by pooling data from published work.
Full publications in the English-language published work as well as abstracts in major international conferences were searched over the past 10 years, and six trials fulfilling the search criteria were found. Outcome measurements included: (i) recurrent bleeding; (ii) requirement of surgical intervention; and (iii) mortality. We examined heterogeneity of trials and pooled the effects by meta-analysis. The quality of studies was graded according to the prospective randomization, methods of patient allocation, the list of exclusion criteria, outcome definitions and the predefined salvage procedures for uncontrolled bleeding.
Among 998 patients recruited in these five randomized trials, 119 received routine second-look endoscopy with thermal coagulation, and 374 received second-look with endoscopic injection and 505 had single endoscopic therapy. Less recurrent bleeding was reported after thermal coagulation (4.2%) than single endoscopy (15.7%) (relative risk [RR] = 0.29; 95% confidence interval [CI] = 0.11-0.73), but no reduction was reported for the requirement of surgical intervention and all-cause mortality. Injection therapy did not reduce re-bleeding (17.6%) when compared to single endoscopy (20.8%; RR = 0.85; 95% CI = 0.63-1.14), requirement for surgery and mortality.
Routine second-look endoscopy with thermal coagulation, but not injection therapy, reduced recurrent peptic ulcer bleeding. There is no proven benefit in reducing surgical intervention and overall mortality.
在消化性溃疡出血的治疗中，二次内镜检查并使用热凝或注射治疗控制再出血的益处并不确定。本研究旨在通过汇集已发表文献的数据，比较常规二次内镜检查与使用热凝或注射治疗与单次内镜治疗的疗效。
在过去 10 年中，检索了英文发表文献和主要国际会议摘要中的完整出版物，并找到了符合搜索标准的六项试验。研究结果包括：（i）再出血；（ii）需要手术干预；（iii）死亡率。我们检查了试验的异质性，并通过荟萃分析合并了效果。根据前瞻性随机分组、患者分组方法、排除标准列表、结果定义以及未控制出血的预定抢救程序，对研究质量进行了分级。
在这五项随机试验中，有 998 名患者入选，其中 119 名患者接受了常规二次内镜检查和热凝治疗，374 名患者接受了二次内镜注射治疗，505 名患者接受了单次内镜治疗。与单次内镜治疗相比，热凝治疗后再出血的发生率较低（4.2% vs 15.7%）（相对风险[RR] = 0.29；95%置信区间[CI] = 0.11-0.73），但手术干预和全因死亡率无降低。与单次内镜治疗相比，注射治疗并未降低再出血率（17.6% vs 20.8%）（RR = 0.85；95%CI = 0.63-1.14）、手术需求和死亡率。
常规二次内镜检查并用热凝治疗，但不是注射治疗，可减少消化性溃疡再出血。在降低手术干预和总体死亡率方面没有明显获益。
