van Brunschot Sandra, Fockens Paul, Bakker Olaf J, Besselink Marc G, Voermans Rogier P, Poley Jan-Werner, Gooszen Hein G, Bruno Marco, van Santvoort Hjalmar C
Department of OR/Clinical Surgical Research, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands,
Surg Endosc. 2014 May;28(5):1425-38. doi: 10.1007/s00464-013-3382-9. Epub 2014 Jan 8.
We performed a systematic review to assess the outcome of endoscopic transluminal necrosectomy in necrotising pancreatitis with additional focus on indication, disease severity, and methodological quality of studies.
We searched the literature published between January 2005 and June 2013. Cohorts, including patients with (infected) necrotising pancreatitis, undergoing endoscopic necrosectomy were included. Indication, disease severity, and methodological quality were described. The main outcomes were mortality, major complications, number of endoscopic sessions, and definitive successful treatment with endoscopic necrosectomy alone.
After screening 581 papers, 14 studies, including 455 patients, fulfilled the eligibility criteria. All included studies were retrospective analyses except for one randomized, controlled trial. Overall methodological quality was moderate to low (mean 5, range 2-9). Less than 50 % of studies reported on pre-procedural severity of disease: mean APACHE-II score before intervention was 8; organ failure was present in 23 % of patients; and infected necrosis in 57 % of patients. On average, four (range 1-23) endoscopic interventions were performed per patient. With endoscopic necrosectomy alone, definitive successful treatment was achieved in 81 % of patients. Mortality was 6 % (28/460 patients) and complications occurred in 36 % of patients. Bleeding was the most common complication.
Endoscopic transluminal necrosectomy is an effective treatment for the majority of patients with necrotising pancreatitis with acceptable mortality and complication rates. It should be noted that methodological quality of the available studies is limited and that the combined patient population of endoscopically treated patients is only moderately ill.
我们进行了一项系统评价，以评估内镜下经腔坏死组织清除术治疗坏死性胰腺炎的效果，并特别关注其适应证、疾病严重程度和研究的方法学质量。
我们检索了2005年1月至2013年6月发表的文献。纳入接受内镜坏死组织清除术的队列研究，包括（感染性）坏死性胰腺炎患者。描述了适应证、疾病严重程度和方法学质量。主要结局指标为死亡率、主要并发症、内镜治疗次数以及单纯内镜坏死组织清除术最终成功治疗的情况。
在筛选581篇论文后，14项研究（包括455例患者）符合纳入标准。除一项随机对照试验外，所有纳入研究均为回顾性分析。总体方法学质量为中到低（平均5分，范围2 - 9分）。不到50%的研究报告了术前疾病严重程度：干预前平均急性生理学与慢性健康状况评分系统（APACHE-II）评分为8分；23%的患者存在器官功能衰竭；57%的患者存在感染性坏死。每位患者平均进行了4次（范围1 - 23次）内镜干预。仅通过内镜坏死组织清除术，81%的患者获得了最终成功治疗。死亡率为6%（460例患者中的28例），36%的患者发生了并发症。出血是最常见的并发症。
内镜下经腔坏死组织清除术对大多数坏死性胰腺炎患者是一种有效的治疗方法，死亡率和并发症发生率可接受。需要注意的是，现有研究的方法学质量有限，且接受内镜治疗患者的总体病情仅为中度。
