Huai Zhang Yu, Feng Xian Wei, Chang Jiang Luo, Xi Chen Wang
Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China.
Gastroenterol Res Pract. 2015;2015:702768. doi: 10.1155/2015/702768. Epub 2015 Jan 29.
Objective. To explore and define the current optimal submucosal injection solution used in ESD and EMR for gastrointestinal tract neoplasms in terms of clinical outcomes and other aspects. Methods. PubMed, Cochrane Library, Embase, and clinical trials register center were searched with terms of "endoscopic resection" and "submucosal injection solution" to identify relevant randomized controlled trials (RCTs). Both direct comparison using traditional meta-analysis method and indirect comparison using network meta-analysis method were performed. Results. A total of 11 RCTs with 1152 patients were included. Meta-analysis showed that, compared with normal saline, other submucosal injection solutions induced a significant increase in terms of en bloc resection rate (I (2) = 0%, OR = 2.11, 95% CI (1.36, 3.26), and P = 0.008) and complete resection rate (I (2) = 0%, OR = 2.14, 95% CI (1.41, 3.24), and P = 0.0003); and there was no significant difference in the incidence of total complications (I (2) = 0%, OR = 0.87, 95% CI (0.59, 1.29), and P = 0.49). Conclusions. Other newly developed submucosal injection solutions significantly increased en bloc resection rate and complete resection rate and decreased bleeding rate and finical cost of endoscopic resection in gastrointestinal tract, while current evidence did not find the difference between them, which need to be explored by further studies.
目的。从临床结果等方面探索并确定目前用于胃肠道肿瘤内镜黏膜下剥离术（ESD）和内镜黏膜切除术（EMR）的最佳黏膜下注射溶液。方法。通过检索PubMed、Cochrane图书馆、Embase和临床试验注册中心，使用“内镜切除术”和“黏膜下注射溶液”等检索词来识别相关的随机对照试验（RCT）。同时采用传统Meta分析方法进行直接比较以及采用网状Meta分析方法进行间接比较。结果。共纳入11项RCT，涉及1152例患者。Meta分析表明，与生理盐水相比，其他黏膜下注射溶液在整块切除率（I² = 0%，OR = 2.11，95%CI（1.36，3.26），P = 0.008）和完整切除率方面显著提高（I² = 0%，OR = 2.14，95%CI（1.41，3.24），P = 0.0003）；而总并发症发生率无显著差异（I² = 0%，OR = 0.87，95%CI（0.59，1.29），P = 0.49）。结论。其他新开发的黏膜下注射溶液显著提高了胃肠道内镜切除术中的整块切除率和完整切除率，并降低了出血率和经济成本，而目前的证据未发现它们之间的差异，这需要进一步研究探索。
