内镜下治疗急性胃静脉曲张出血时氰基丙烯酸酯注射与套扎术的比较：基于PRISMA声明的随机对照研究的Meta分析
Cyanoacrylate Injection Versus Band Ligation in the Endoscopic Management of Acute Gastric Variceal Bleeding: Meta-Analysis of Randomized, Controlled Studies Based on the PRISMA Statement.
作者信息
Qiao Weiguang, Ren Yutang, Bai Yang, Liu Side, Zhang Qiang, Zhi Fachao
机构信息
From the Guangdong Provincial Key Laboratory of Gastroenterology (WQ, YB, SL, QZ, FZ), and Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China (WQ, YB, SL, QZ, FZ); and Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China (YR).
出版信息
Medicine (Baltimore). 2015 Oct;94(41):e1725. doi: 10.1097/MD.0000000000001725.
The evidence for optimal endoscopic management of bleeding gastric varices is lacking. The clinical outcome is controversial in trials comparing cyanoacrylate injection and band ligation. To help guide endoscopic decisions regarding acute gastric variceal bleeding, a meta-analysis was conducted.Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ScienceDirect were searched for all randomized controlled trials (RCTs) containing the 2 interventions. The main outcomes evaluated in the meta-analysis were active bleeding control, blood transfusion, rebleeding, recurrence of varices, complications, and survival.Three RCTs were identified, which included 194 patients with active gastric variceal bleeding from Taiwan and Romania. Active bleeding control was achieved in 46 of 49 (93.9%) patients in the cyanoacrylate injection group, compared with 35 of 44 (79.5%) in the band ligation group (P = 0.032), for a pooled odds ratio of 4.44 (95% confidence interval, 1.14-17.30). Rebleeding rate was comparable in type 2 gastroesophageal varices (GOV2) between the 2 interventions (35.7% vs 34.8%, P = 0.895), but cyanoacrylate injection seemed superior for reducing rebleeding rate in type 1 gastroesophageal varices (GOV1, 26.1% vs 47.7%, P = 0.035) and type 1 isolated gastric varices (IGV1, 17.6% vs 85.7%, P = 0.015). Cyanoacrylate injection was also superior in controlling recurrence of gastric varices to band ligation (36.0% vs 66.0%, P = 0.002). There was no difference in complications or mortality between the 2 interventions. The major limitation of this meta-analysis is the small number of studies/patients included.Compared with band ligation, injection cyanocrylate have an advantage in the control of acute gastric variceal bleeding, also with lower recurrence rate and rebleeding (except GOV2). The limited amount of studies included attenuates the strength of this meta-analysis; therefore, more high-quality RCTs are needed.
目前缺乏关于胃静脉曲张出血最佳内镜治疗的证据。在比较氰基丙烯酸酯注射和套扎术的试验中，临床结果存在争议。为了帮助指导关于急性胃静脉曲张出血的内镜决策，我们进行了一项荟萃分析。我们在Cochrane对照试验中央登记库、MEDLINE、EMBASE和ScienceDirect中检索了所有包含这两种干预措施的随机对照试验（RCT）。荟萃分析中评估的主要结局包括活动性出血控制、输血、再出血、静脉曲张复发、并发症和生存率。我们确定了三项RCT，其中包括来自台湾和罗马尼亚的194例活动性胃静脉曲张出血患者。氰基丙烯酸酯注射组49例患者中有46例（93.9%）实现了活动性出血控制，相比之下，套扎术组44例患者中有35例（79.5%）实现了活动性出血控制（P = 0.032），合并比值比为4.44（95%置信区间，1.14 - 17.30）。在2型胃食管静脉曲张（GOV2）中，两种干预措施的再出血率相当（35.7%对34.8%，P = 0.895），但在减少1型胃食管静脉曲张（GOV1，26.1%对47.7%，P = 0.035）和1型孤立性胃静脉曲张（IGV1，17.6%对85.7%，P = 0.015）的再出血率方面，氰基丙烯酸酯注射似乎更具优势。在控制胃静脉曲张复发方面，氰基丙烯酸酯注射也优于套扎术（36.0%对66.0%，P = 0.002）。两种干预措施在并发症或死亡率方面没有差异。这项荟萃分析的主要局限性是纳入的研究/患者数量较少。与套扎术相比，注射氰基丙烯酸酯在控制急性胃静脉曲张出血方面具有优势，复发率和再出血率也较低（GOV2除外）。纳入的研究数量有限削弱了这项荟萃分析的力度；因此，需要更多高质量的RCT。
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