Portland VA Medical Center and Oregon Health & Science University, Portland, Oregon 97239,USA.
Am J Gastroenterol. 2012 Mar;107(3):339-42. doi: 10.1038/ajg.2011.426.
The benefit of repeat colonoscopy in managing delayed postpolypectomy bleeding is unknown. This study aimed to assess the outcome of repeat colonoscopy to achieve hemostasis.
Endoscopic management of postpolypectomy bleeding is modeled as a decision tree, measuring the expected overall fraction of patients who benefit from therapeutic hemostasis and the number of patients needed to treat (NNT) in order to achieve one beneficial hemostasis.
A repeat colonoscopy to identify and treat postpolypectomy bleeding is beneficial in about 22% of patients, corresponding to an NNT of 4.5 patients. The outcome of the model is sensitive to assumptions underlying the fractions of patients who need treatment and would benefit from successful endoscopic hemostasis. Varying these probabilities over a broad range changes the fraction of patients benefiting from endoscopy between 3% and 33% and the NNT between 28 and 3 patients, respectively.
The expected outcome of repeat colonoscopy justifies the endoscopic attempts at therapeutic hemostasis. The results also suggest that in many patients expectant management aimed at spontaneous resolution of the bleeding remains a valid option.
重复结肠镜检查在治疗延迟性息肉切除术后出血中的获益尚不清楚。本研究旨在评估重复结肠镜检查以实现止血的效果。
将息肉切除术后出血的内镜治疗建模为决策树，衡量接受治疗性止血获益的患者的预期总体比例以及为实现一次有益止血所需治疗的患者数量（NNT）。
重复结肠镜检查以识别和治疗息肉切除术后出血对约 22%的患者有益，对应的 NNT 为 4.5 例。该模型的结果对需要治疗和成功内镜止血获益的患者比例的假设敏感。在广泛的范围内改变这些概率会使接受内镜治疗获益的患者比例在 3%至 33%之间变化，NNT 在 28 和 3 例之间变化。
重复结肠镜检查的预期结果证明了内镜治疗止血的尝试是合理的。结果还表明，在许多患者中，针对出血自发性缓解的期待性治疗仍然是一种有效的选择。
