老年患者的器械辅助式小肠镜检查：系统评价和荟萃分析。

Device assisted enteroscopy in the elderly - A systematic review and meta-analysis.

机构信息

Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.

出版信息

Dig Liver Dis. 2019 Sep;51(9):1249-1256. doi: 10.1016/j.dld.2019.04.001. Epub 2019 Apr 27.

DOI:10.1016/j.dld.2019.04.001

PMID:31036473

Abstract

BACKGROUND

Device assisted enteroscopy (DAE) is increasingly being carried out in elderly patients. This provides a challenge due to the underlying varied physiology and comorbidities these patients have.

METHODS

We performed a systematic literature search for studies on elderly patients undergoing DAE. We calculated the pooled diagnostic (DY) and therapeutic yields (TY), major adverse events, length of small bowel examined and sedation administered. These were also compared to younger patients.

RESULTS

Fourteen high quality articles on DAE in the elderly were included in this analysis (3289 total, 1712 elderly) patients. Nine of these studies were included in the final meta-analysis (681 elderly, 1577 young patients). The overall DY of DAE, double balloon enterosocpy (DBE) and single balloon enteroscopy (SBE) were 0.68 (p = 0.000001), 1.74 (p = 0.0001) and 1.90 (p = 0.009). The TY of DAE, DBE and SBE were 0.45 (p = 0.00001), 2.20 (p = 0.00001) and 2.36 (p = 0.00001). On comparison of elderly and young patients, DY (1.83; 95% CI: 1.49, 2.24; p = 0.00001) and TY (2.28; 95% CI: 1.79, 2.89) were better in elderly patients. There was no difference in adverse events in both groups (2.16; 95% CI: 0.82, 5.69, p = 0.12). Elderly patients were given less sedation than younger patients during DAE.

CONCLUSIONS

DAE has a higher DY and TY in the elderly than younger patients. DAE can be safely carried out in the elderly with less sedation.

摘要

背景

设备辅助的小肠镜检查（DAE）在老年患者中越来越普遍。由于这些患者存在不同的基础生理机能和合并症，这给治疗带来了挑战。

方法

我们对接受 DAE 的老年患者的研究进行了系统的文献检索。我们计算了汇总的诊断（DY）和治疗效果（TY）、主要不良事件、检查的小肠长度和给予的镇静剂。并将这些与年轻患者进行比较。

结果

纳入了 14 篇关于老年患者 DAE 的高质量文章，共纳入 3289 名患者（1712 名老年患者）。其中 9 项研究纳入最终的荟萃分析（681 名老年患者，1577 名年轻患者）。DAE、双气囊小肠镜（DBE）和单气囊小肠镜（SBE）的总体 DY 分别为 0.68（p=0.000001）、1.74（p=0.0001）和 1.90（p=0.009）。DAE、DBE 和 SBE 的 TY 分别为 0.45（p=0.00001）、2.20（p=0.00001）和 2.36（p=0.00001）。与年轻患者相比，老年患者的 DY（1.83；95%CI：1.49，2.24；p=0.00001）和 TY（2.28；95%CI：1.79，2.89）更好。两组的不良事件无差异（2.16；95%CI：0.82，5.69，p=0.12）。在 DAE 过程中，老年患者给予的镇静剂少于年轻患者。