Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Gastrointest Endosc. 2015 Oct;82(4):618-28.e5. doi: 10.1016/j.gie.2015.03.1977. Epub 2015 May 21.
Surgical repair of endoscopic perforations of the GI tract used to be the standard, but immediate, secure endoscopic closure has become an attractive alternative treatment with the potential to reduce morbidity and mortality.
We aimed to perform a systematic review of the medical literature on endoscopic closure of acute iatrogenic perforations of the GI tract.
A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines.
Available medical literature from 1966 through November 2013.
Patients with an acute perforation after an endoscopic procedure that was closed endoscopically.
Endoscopic closure of an acute perforation of the GI tract.
Clinically successful endoscopic closure.
In our search, we identified 726 studies, 702 of which had to be excluded. Twenty-four cohort studies (21 retrospective, 3 prospective) were included in the analysis. No randomized trials were identified. Overall, the methodological quality was low. The 24 studies included described 466 acute perforations in which endoscopic closure was attempted. Successful endoscopic closure was achieved in 419 cases (89.9%; 95% CI, 87%-93%). Successful closure was achieved in 90.2% (n = 359; 95% CI, 87%-93%) of cases by using endoclips, in 87.8% (n = 58; 95% CI, 78%-95%) by using the over-the-scope-clip, and in 100% (n = 2) by using a metal stent.
Low methodological quality of included studies.
This systematic review suggests that endoscopic perforation closure is a safe and effective alternative for surgical intervention in selected cases; however, the overall methodological quality was low. Prospective, true consecutive studies are needed to define the definitive role of endoscopic closure of perforations.
过去，胃肠内镜穿孔的手术修复是标准治疗方法，但即时、安全的内镜封闭已成为一种有吸引力的替代治疗方法，有可能降低发病率和死亡率。
我们旨在对胃肠内镜急性医源性穿孔内镜封闭的医学文献进行系统评价。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行系统评价。
可获得的医学文献来自 1966 年至 2013 年 11 月。
内镜手术后出现急性穿孔并接受内镜封闭治疗的患者。
胃肠内镜急性穿孔的内镜封闭。
临床成功的内镜封闭。
在我们的搜索中，我们确定了 726 项研究，其中 702 项必须排除。24 项队列研究（21 项回顾性，3 项前瞻性）被纳入分析。未发现随机试验。总体而言，方法学质量较低。这 24 项研究共描述了 466 例尝试内镜封闭的急性穿孔。419 例（89.9%；95%CI，87%-93%）成功实现内镜封闭。使用内镜夹成功封闭的比例为 90.2%（n=359；95%CI，87%-93%），使用内镜下夹闭器的比例为 87.8%（n=58；95%CI，78%-95%），使用金属支架的比例为 100%（n=2）。
纳入研究的方法学质量较低。
这项系统评价表明，在某些情况下，内镜穿孔封闭是手术干预的一种安全有效的替代方法；然而，总体方法学质量较低。需要前瞻性、真实连续的研究来确定内镜穿孔封闭的明确作用。
