Romagnuolo Joseph, Brock Andrew S, Ranney Nathaniel
*Department of Public Health Sciences, Medical University of South Carolina †Department of Medicine, Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC.
J Clin Gastroenterol. 2015 Nov-Dec;49(10):823-30. doi: 10.1097/MCG.0000000000000266.
We aimed to summarize pooled rebleeding rates of angioectasia after therapeutic endoscopy, and compare these to historical control (no intervention) rates.
Obscure gastrointestinal bleeding continues to be challenging to diagnose and treat; in America, small bowel angioectasias are the most common cause. Technology advances led to higher diagnostic yield for these lesions; however, therapeutic impact of endoscopy remains unclear.
A PubMed search (June 1, 2006 to September 19, 2013) with 2 independent reviews sought articles reporting rebleeding rates of symptomatic angioectasia without therapy (natural history) and after endoscopic treatment. This study list was added to studies in the 2007 American Gastroenterological Association systematic review. Data on number of patients who underwent endoscopic therapy, type of therapy used, number of patients who experienced rebleeding, and follow-up time were extracted. Rebleeding data were pooled and weighted averages were reported with 95% confidence intervals (CI).
Twenty-four articles (n=490 patients) with data on endoscopic therapy for angioectasia and 6 natural history cohorts (n=130) receiving no therapy for angioectasia were eligible. Of the endoscopic therapy patients, 121 at push enteroscopy and 427 at balloon-assisted enteroscopy; 209/490 (42.7%; 95% CI, 38%-47%) rebled. Of the control (no therapy) patients, 64/130 (49.2%; 95% CI, 40%-58%) rebled. Number needed to treat is estimated at 15 to 16.
Rebleeding rate after endoscopic therapy for symptomatic small bowel angioectasia may be comparable to that expected without therapy. Endoscopic therapy may be ineffective; if effective, the needed to treat is estimated to be high. Controlled studies, with intervention-stratified and etiology-stratified outcomes are needed.
我们旨在总结治疗性内镜检查后血管扩张症的汇总再出血率，并将其与历史对照（无干预）率进行比较。
不明原因的胃肠道出血在诊断和治疗上仍然具有挑战性；在美国，小肠血管扩张症是最常见的病因。技术进步提高了这些病变的诊断率；然而，内镜检查的治疗效果仍不明确。
通过PubMed检索（2006年6月1日至2013年9月19日），由两名独立评审员寻找报告有症状血管扩张症未经治疗（自然病程）和内镜治疗后再出血率的文章。该研究列表被纳入2007年美国胃肠病学会系统评价中的研究。提取了接受内镜治疗的患者数量、所用治疗类型、发生再出血的患者数量以及随访时间的数据。汇总再出血数据，并报告加权平均值及95%置信区间（CI）。
24篇文章（n = 490例患者）提供了血管扩张症内镜治疗的数据，6个自然病程队列（n = 130例）未接受血管扩张症治疗。在内镜治疗患者中，推进式小肠镜检查121例，气囊辅助小肠镜检查427例；209/490（42.7%；95%CI，38% - 47%）发生再出血。在对照（未治疗）患者中，64/130（49.2%；95%CI，40% - 58%）发生再出血。估计治疗所需人数为15至16。
有症状的小肠血管扩张症内镜治疗后的再出血率可能与未经治疗时预期的再出血率相当。内镜治疗可能无效；如果有效，估计治疗所需人数较高。需要进行有干预分层和病因分层结果的对照研究。
