Tullavardhana Thawatchai, Akranurakkul Prinya, Ungkitphaiboon Withoon, Songtish Dolrudee
Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok, Thailand.
Ann Med Surg (Lond). 2017 Jun 6;19:65-73. doi: 10.1016/j.amsu.2017.05.035. eCollection 2017 Jul.
Bleeding is the most common major complication following colonoscopic polypectomy. The purpose of this study is to evaluate whether submucosal epinephrine injections could prevent the occurrence of postpolypectomy bleeding.
The dataset was defined by searching PubMed, EMBASE, Google Scholar, and the Cochrane database for appropriate randomized controlled studies published before April 2015. A meta-analysis was conducted to investigate the preventative effect of submucosal epinephrine injection for overall, early, and delayed postpolypectomy bleeding.
The final analysis examined the findings of six studies, with data from 1388 patients. The results demonstrated that prophylactic treatment with epinephrine injection significantly reduced the occurrence of overall (OR = 0.38, 95% CI: 0.21, 0.66; p = 0.0006) and early bleeding (OR = 0.38, 95% CI: 0.20, 0.69; p = 0.002). However, for delayed bleeding complications, epinephrine injections were not found to be any more effective than treatment with saline injection or no injection (OR = 0.45, 95% CI: 0.11, 1.81; p = 0.26). Moreover, for patients with polyps larger than 20 mm, mechanical hemostasis devices (endoloops or clips) were found to be more effective than epinephrine injection in preventing overall bleeding (OR = 0.33, 95% CI: 0.13, 0.87; p = 0.03) and early bleeding (OR = 0.29, 95% CI: 0.08, 1.02; p = 0.05). This was not established for delayed bleeding.
The routine use of prophylaxis submucosal epinephrine injection is safe and beneficial preventing postpolypectomy bleeding.
出血是结肠镜息肉切除术后最常见的主要并发症。本研究的目的是评估黏膜下注射肾上腺素是否能预防息肉切除术后出血的发生。
通过检索PubMed、EMBASE、谷歌学术和考克兰数据库来确定数据集，纳入2015年4月之前发表的合适的随机对照研究。进行荟萃分析以研究黏膜下注射肾上腺素对息肉切除术后总体、早期和延迟出血的预防效果。
最终分析纳入了六项研究的结果，涉及1388例患者的数据。结果表明，注射肾上腺素进行预防性治疗可显著降低总体出血（比值比[OR]=0.38，95%置信区间[CI]：0.21，0.66；p=0.0006）和早期出血（OR=0.38，95%CI：0.20，0.69；p=0.002）的发生率。然而，对于延迟出血并发症，未发现注射肾上腺素比注射生理盐水或不注射更有效（OR=0.45，95%CI：0.11，1.81；p=0.26）。此外，对于息肉大于20毫米的患者，在预防总体出血（OR=0.33，95%CI：0.13，0.87；p=0.03）和早期出血（OR=0.29，95%CI：0.08，1.02；p=0.05）方面，机械止血装置（内镜圈套器或夹子）比注射肾上腺素更有效。但对于延迟出血，情况并非如此。
常规预防性黏膜下注射肾上腺素对于预防息肉切除术后出血是安全且有益的。
