Baracat Felipe, Moura Eduardo, Bernardo Wanderley, Pu Leonardo Zorron, Mendonça Ernesto, Moura Diogo, Baracat Renato, Ide Edson
Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo Medical School, Avenida Dr. Enéas de Carvalho Aguiar, 155, 6° andar, São Paulo, SP, CEP 05403-900, Brazil.
, Rua Martinico Prado, 241, apt 94, CEP 01224-010, São Paulo, SP, Brazil.
Surg Endosc. 2016 Jun;30(6):2155-68. doi: 10.1007/s00464-015-4542-x. Epub 2015 Oct 20.
Peptic ulcer represents the most common cause of upper gastrointestinal bleeding. Endoscopic therapy can reduce the risks of rebleeding, continued bleeding, need for surgery, and mortality. The objective of this review is to compare the different modalities of endoscopic therapy.
Studies were identified by searching electronic databases MEDLINE, Embase, Cochrane, LILACS, DARE, and CINAHL. We selected randomized clinical trials that assessed contemporary endoscopic hemostatic techniques. The outcomes evaluated were: initial hemostasis, rebleeding rate, need for surgery, and mortality. The possibility of publication bias was evaluated by funnel plots. An additional analysis was made, including only the higher-quality trials.
Twenty-eight trials involving 2988 patients were evaluated. Injection therapy alone was inferior to injection therapy with hemoclip and with thermal coagulation when evaluating rebleeding and the need for emergency surgery. Hemoclip was superior to injection therapy in terms of rebleeding; there were no statistically significant differences between hemoclip alone and hemoclip with injection therapy. There was considerable heterogeneity in the comparisons between hemoclip and thermal coagulation. There were no statistically significant differences between thermal coagulation and injection therapy, though their combination was superior, in terms of rebleeding, to thermal coagulation alone.
Injection therapy should not be used alone. Hemoclip is superior to injection therapy, and combining hemoclip with an injectate does not improve hemostatic efficacy above hemoclip alone. Thermal coagulation has similar efficacy as injection therapy; combining these appears to be superior to thermal coagulation alone. Therefore, we recommend the application of hemoclips or the combined use of injection therapy with thermal coagulation for the treatment of peptic ulcer bleeding.
消化性溃疡是上消化道出血最常见的原因。内镜治疗可降低再出血、持续出血、手术需求及死亡率。本综述的目的是比较不同的内镜治疗方式。
通过检索电子数据库MEDLINE、Embase、Cochrane、LILACS、DARE和CINAHL来识别研究。我们选择了评估当代内镜止血技术的随机临床试验。评估的结局包括：初始止血、再出血率、手术需求和死亡率。通过漏斗图评估发表偏倚的可能性。进行了一项额外分析，仅纳入质量较高的试验。
评估了28项涉及2988例患者的试验。在评估再出血和急诊手术需求时，单纯注射疗法不如注射疗法联合止血夹及热凝疗法。在再出血方面，止血夹优于注射疗法；单纯止血夹与注射疗法联合止血夹之间无统计学显著差异。止血夹与热凝疗法的比较存在相当大的异质性。热凝疗法与注射疗法之间无统计学显著差异，不过在再出血方面，两者联合优于单纯热凝疗法。
不应单独使用注射疗法。止血夹优于注射疗法，且将止血夹与注射剂联合使用并不能比单纯使用止血夹提高止血效果。热凝疗法与注射疗法疗效相似；两者联合似乎优于单纯热凝疗法。因此，我们建议应用止血夹或联合使用注射疗法与热凝疗法来治疗消化性溃疡出血。
