Pontone Stefano, Giusto Michela, Filippini Angelo, Cicerone Clelia, Pironi Daniele, Merli Manuela
Department of Surgical Sciences, "Sapienza" University of Rome, Italy.
Department of Clinical Medicine, "Sapienza" University of Rome, Italy.
Gastroenterol Hepatol Bed Bench. 2016 Winter;9(1):6-11.
The aim of this systematic review was to evaluate the current reported efficacy and the mortality rate of SEMS treatment in uncontrolled bleeding patients.
Esophageal variceal bleeding (EVB) represents a life threatening pathology. Despite the adequate pharmacologic and endoscopic treatment, continuous or recurrent bleeding, named as uncontrolled bleeding, occurs in 10-20% of cases. A new removable, covered, and self-expanding metal stent (SEMS) was proposed to control the variceal bleeding.
The study was conducted according to the PRISMA statement. Studies were identified by searching MEDLINE (1989-present) and SCOPUS (1989-present) databases. The last search was run on 01 July 2015.
Nine studies (period range=2002-2015) met the inclusion criteria and were included in quantitative analysis. High rate of SEMS efficacy in controling acute bleeding was observed, with a reported percentage ranging from 77.7 to 100%. In 10% to 20% of patients, re-bleeding occurred with SEMS in situ. Stent deployment was successful in 77.8% to 100% of patients while 11 to 36.5% of patients experienced stent migration.
SEMS could be effective and safe in control EVB and can be proposed as a reliable option to ballon tamponed for patient stabilization and as a bridging to other therapeutic approach.
本系统评价的目的是评估目前报道的可扩张金属支架（SEMS）治疗难治性出血患者的疗效及死亡率。
食管静脉曲张破裂出血（EVB）是一种危及生命的疾病。尽管有足够的药物和内镜治疗，但仍有10%-20%的病例会出现持续性或复发性出血，即难治性出血。一种新型可取出、带膜、自膨式金属支架（SEMS）被用于控制静脉曲张出血。
本研究按照系统评价和Meta分析的首选报告项目（PRISMA）声明进行。通过检索MEDLINE（1989年至今）和SCOPUS（1989年至今）数据库来识别研究。最后一次检索于2015年7月1日进行。
9项研究（时间范围为2002-2015年）符合纳入标准并纳入定量分析。观察到SEMS控制急性出血的有效率较高，报告的百分比范围为77.7%-100%。10%-20%的患者在SEMS在位时再次出血。支架置入成功率为77.8%-100%，而11%-36.5%的患者发生支架移位。
SEMS控制EVB可能有效且安全，可作为气囊压迫止血稳定患者病情的可靠选择，并作为其他治疗方法的桥梁。
