Oakland Kathryn, Isherwood Jennifer, Lahiff Conor, Goldsmith Petra, Desborough Michael, Colman Katherine S, Guy Richard, Uberoi Raman, Murphy Michael F, East James E, Hopewell Sally, Jairath Vipul
NHS Blood and Transplant, Oxford, United Kingdom.
Department of General Surgery, Milton Keynes Hospital, Milton Keynes, United Kingdom.
Endosc Int Open. 2017 Oct;5(10):E959-E973. doi: 10.1055/s-0043-117958. Epub 2017 Sep 29.
Investigations for lower gastrointestinal bleeding (LGIB) include flexible sigmoidoscopy, colonoscopy, computed tomographic angiography (CTA), and angiography. All may be used to direct endoscopic, radiological or surgical treatment, although their optimal use is unknown. The aims of this study were to determine the diagnostic and therapeutic yields of endoscopy, CTA, and angiography for managing LGIB, and their influence on rebleeding, transfusion, and hospital stay.
A systematic search of MEDLINE, PubMed, EMBASE, and CENTRAL was undertaken to identify randomized controlled trials (RCTs) and nonrandomized studies of intervention (NRSIs) published between 2000 and 12 November 2015 in patients hospitalized with LGIB. Separate meta-analyses were conducted, presented as pooled odds (ORs) or risk ratios (RR) with 95 % confidence intervals (CIs).
Two RCTs and 13 NRSIs were included, none of which examined flexible sigmoidoscopy, or compared endotherapy with embolization, or investigated the timing of CTA or angiography. Two NRSIs (57 - 223 participants) comparing colonoscopy and CTA were of insufficient quality for synthesis but showed no difference in diagnostic yields between the two interventions. One RCT and 4 NRSIs (779 participants) compared early colonoscopy (< 24 hours) with colonoscopy performed later; meta-analysis of the NRSIs demonstrated higher diagnostic and therapeutic yields with early colonoscopy (OR 1.86, 95 %CI 1.12 to 2.86, = 0.004 and OR 3.08, 95 %CI 1.93 to 4.90, < 0.001, respectively) and reduced length of stay (mean difference 2.64 days, 95 %CI 1.54 to 3.73), but no difference in transfusion or rebleeding.
In LGIB there is a paucity of high-quality evidence, although the limited studies on the timing of colonoscopy suggest increased rates of diagnosis and therapy with early colonoscopy.
下消化道出血（LGIB）的检查方法包括乙状结肠镜检查、结肠镜检查、计算机断层血管造影（CTA）和血管造影。所有这些检查都可用于指导内镜、放射或手术治疗，但其最佳应用尚不清楚。本研究的目的是确定内镜检查、CTA和血管造影在管理LGIB方面的诊断和治疗效果，以及它们对再出血、输血和住院时间的影响。
对MEDLINE、PubMed、EMBASE和CENTRAL进行系统检索，以识别2000年至2015年11月12日期间发表的关于LGIB住院患者的随机对照试验（RCT）和非随机干预研究（NRSI）。进行了单独的荟萃分析，以合并比值比（OR）或风险比（RR）以及95%置信区间（CI）呈现。
纳入了2项RCT和13项NRSI，其中没有一项研究乙状结肠镜检查，或比较内镜治疗与栓塞治疗，或研究CTA或血管造影的时机。2项比较结肠镜检查和CTA的NRSI（57 - 223名参与者）质量不足以进行综合分析，但显示两种检查的诊断效果无差异。1项RCT和4项NRSI（779名参与者）比较了早期结肠镜检查（<24小时）与后期进行的结肠镜检查；对NRSI的荟萃分析表明，早期结肠镜检查的诊断和治疗效果更高（OR分别为1.86，95%CI为1.12至2.86，P = 0.004和OR为3.08，95%CI为1.93至4.90，P < 0.001），住院时间缩短（平均差异2.64天，95%CI为1.54至3.73），但输血或再出血方面无差异。
在LGIB方面，高质量证据匮乏，尽管关于结肠镜检查时机的有限研究表明早期结肠镜检查的诊断和治疗率有所提高。
