使用黏液溶解剂进行预处理是否能改善食管胃十二指肠镜检查时的黏膜可视化：一项系统评价和荟萃分析
Does Premedication with Mucolytic Agents Improve Mucosal Visualization during Oesophagogastroduodenoscopy: A Systematic Review and Meta-Analysis.
作者信息
Burke Eoghan, Harkins Patricia, Moriarty Frank, Ahmed Ibrahim
机构信息
Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland.
St James's Hospital, Dublin, Ireland.
出版信息
Surg Res Pract. 2021 Jan 22;2021:1570121. doi: 10.1155/2021/1570121. eCollection 2021.
INTRODUCTION
Gastric Cancer (GC) is the fourth most common malignancy worldwide and the second leading cause of cancer-related mortality for both sexes. The gold standard for diagnosing GC is oesophagogastroduodenoscopy (OGD). Excess mucus on the gastric mucosa impairs the detection of early GC.
AIM
To synthesize available evidence of the effect of premedication with a mucolytic agent among adults undergoing elective nontherapeutic OGD, compared to placebo or other mucolytic agents, on mucosal visibility during OGD.
METHODS
A systematic review was conducted. PubMed, EMBASE, CINAHL, Cochrane central register of controlled trials (CENTRAL), and Web of Science were searched for relevant studies. A random-effects meta-analysis was performed to determine the mean difference in total mucosal visibility score (TMVS) between the pooled mucolytic agents and control. Subgroup analyses were performed to determine the mean TMVS difference for simethicone versus control and the impact of different timings and doses of mucolytic premedication.
RESULTS
13 studies, involving 11,086 patients, including 6178 females (55.7%), with a mean age of 53.4 were identified and 6 of these were brought forward to meta-analysis. This revealed a mean difference of -2.69 (95% CI -3.5, -1.88) in total mucosal visibility scores (TMVS) between the pooled mucolytic agents and control. For simethicone, the mean difference was -2.68 (95% CI -4.94, -0.43). A simethicone dose of 133 mg was most effective with a mean difference of -4.22 (95% CI -5.11, -3.33). Assessing timing of administration across all mucolytic agents revealed a mean difference for the >20 minutes group of -3.68 (95% CI -4.77, -2.59). No adverse events were reported in any included trials.
CONCLUSIONS
Regular use of premedication with mucolytic agents prior to routine OGD is associated with improved TMVS with no reported adverse events.
引言
胃癌（GC）是全球第四大常见恶性肿瘤，也是男女癌症相关死亡的第二大主要原因。诊断胃癌的金标准是食管胃十二指肠镜检查（OGD）。胃黏膜上过多的黏液会影响早期胃癌的检测。
目的
与安慰剂或其他黏液溶解剂相比，综合分析在接受择期非治疗性OGD的成年人中使用黏液溶解剂进行预处理对OGD期间黏膜可见度的影响的现有证据。
方法
进行了一项系统评价。检索了PubMed、EMBASE、CINAHL、Cochrane对照试验中央注册库（CENTRAL）和科学网以查找相关研究。进行随机效应荟萃分析以确定汇总的黏液溶解剂与对照组之间总黏膜可见度评分（TMVS）的平均差异。进行亚组分析以确定西甲硅油与对照组的平均TMVS差异以及黏液溶解剂预处理的不同时间和剂量的影响。
结果
确定了13项研究，涉及11086名患者，其中包括6178名女性（55.7%），平均年龄为53.4岁，其中6项被纳入荟萃分析。这显示汇总的黏液溶解剂与对照组之间的总黏膜可见度评分（TMVS）平均差异为-2.69（95%CI -3.5，-1.88）。对于西甲硅油，平均差异为-2.68（95%CI -4.94，-0.43）。133毫克的西甲硅油剂量最有效，平均差异为-4.22（95%CI -5.11，-3.33）。评估所有黏液溶解剂的给药时间显示，>20分钟组的平均差异为-3.68（95%CI -4.77，-2.59）。纳入的任何试验均未报告不良事件。
结论
在常规OGD之前定期使用黏液溶解剂进行预处理与TMVS改善相关，且未报告不良事件。
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