Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China.
Int J Colorectal Dis. 2011 Jun;26(6):709-19. doi: 10.1007/s00384-011-1141-8. Epub 2011 Feb 11.
The aim of this meta-analysis and systematic review was to determine whether bleeding prophylaxis benefits patients after colonoscopic polypectomy.
A systematic review of the literature was performed to find prospective randomized controlled trials of postpolypectomy hemorrhage prophylaxis. Studies were selected according to specific criteria and analyzed to generate pooled data.
Eight studies encompassing 2,595 polyps met the criteria for the meta-analysis. The rate of early bleeding was significantly decreased relative to the control when a single prophylactic technique was used [2.58% vs. 8.15%, OR = 0.34 (95% CI, 0.20-0.58), P < 0.0001]. The use of multiple prophylactic techniques resulted in a lower early postpolypectomy hemorrhage rate compared with the use of a single prophylactic technique [0% vs. 8.41%, OR = 0.12 (95% CI, 0.03-0.47), P = 0.002]. The late bleeding rate did not differ significantly between the monotherapy and control groups [0.61% vs. 1.39%, OR = 0.37 (95% CI, 0.11-1.28), P = 0.12], and the use of combined preventative techniques did not significantly decrease the late postpolypectomy bleeding (PPB) rate compared with use of a single prophylactic method [1.43% vs. 2.05%, OR = 0.70 (95% CI, 0.32-1.55), P = 0.38].
Prophylactic endoscopic treatments are effective at reducing early PPB after colonoscopic polypectomy. However, patients with late PPB may not benefit from bleeding prophylaxis.
本荟萃分析和系统评价旨在确定结肠镜息肉切除术后预防性出血治疗是否有益于患者。
对预防结直肠息肉切除术后出血的前瞻性随机对照试验进行了系统文献回顾。根据具体标准选择研究并进行分析以生成汇总数据。
符合荟萃分析标准的有 8 项研究，共纳入 2595 枚息肉。与对照组相比，单一预防性治疗技术可显著降低早期出血率[2.58% vs. 8.15%，OR=0.34（95%CI，0.20-0.58），P<0.0001]。与单一预防性治疗技术相比，联合使用多种预防性治疗技术可降低早期结直肠息肉切除术后出血率[0% vs. 8.41%，OR=0.12（95%CI，0.03-0.47），P=0.002]。与对照组相比，单药治疗组的迟发性出血率无显著差异[0.61% vs. 1.39%，OR=0.37（95%CI，0.11-1.28），P=0.12]，联合预防性治疗技术与单一预防性治疗方法相比，并未显著降低迟发性结直肠息肉切除术后出血率[1.43% vs. 2.05%，OR=0.70（95%CI，0.32-1.55），P=0.38]。
预防性内镜治疗可有效降低结肠镜息肉切除术后早期结直肠息肉切除术后出血率。然而，迟发性结直肠息肉切除术后出血的患者可能不能从预防性出血治疗中获益。
