Chevallier Olivier, Guillen Kévin, Comby Pierre-Olivier, Mouillot Thomas, Falvo Nicolas, Bardou Marc, Midulla Marco, Aho-Glélé Ludwig-Serge, Loffroy Romaric
Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France.
Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France.
J Clin Med. 2021 May 25;10(11):2298. doi: 10.3390/jcm10112298.
We performed a systematic review and meta-analysis of published studies to assess the efficacy, safety, and outcomes of N-butyl cyanoacrylate (NBCA) injection for the treatment of variceal gastrointestinal bleeding (GIB). The MEDLINE/PubMed, EMBASE, and SCOPUS databases were searched for English-language studies published from January 1980 to December 2019 and including patients who had injection of NBCA for variceal GIB. Two independent reviewers extracted and evaluated the data from eligible studies. Exclusion criteria were sample size < 5, article reporting the use of NBCA with other embolic agents, no extractable data, and duplicate reports. NBCA was injected during endoscopy in 42 studies and through a direct percutaneous approach for stomal varices in 1 study. The study's endpoints were: Technical success, 30-day rebleeding, and 30-day overall and major complications. The estimated overall rates were computed with 95% confidence intervals, based on each study rate, weighted by the number of patients involved in each study. In total, 43 studies with 3484 patients were included. The technical success rate was 94.1% (95% CI: 91.6-96.1%), the 30-day rebleeding rate was 24.2% (18.9-29.9%), and 30-day overall and major complications occurred in 15.9% (11.2-21.3%) and 5.3% (3.3-7.8%) of patients, respectively. For treating variceal GIB, NBCA injection is a safe and effective method that demonstrates high technical success rate and very low major complication rate.
我们对已发表的研究进行了系统评价和荟萃分析，以评估氰基丙烯酸正丁酯（NBCA）注射治疗静脉曲张性胃肠道出血（GIB）的疗效、安全性和结局。检索MEDLINE/PubMed、EMBASE和SCOPUS数据库，查找1980年1月至2019年12月发表的英文研究，纳入接受NBCA注射治疗静脉曲张性GIB的患者。两名独立的评审员从符合条件的研究中提取并评估数据。排除标准为样本量<5、报告NBCA与其他栓塞剂联合使用的文章、无可提取数据以及重复报告。42项研究在内镜检查期间注射NBCA，1项研究通过直接经皮途径注射治疗造口静脉曲张。该研究的终点为：技术成功率、30天再出血率以及30天总体和主要并发症发生率。根据每项研究的发生率，并按每项研究涉及的患者数量加权，计算出95%置信区间的总体估计率。总共纳入了43项研究，涉及3484例患者。技术成功率为94.1%（95%CI：91.6-96.1%），30天再出血率为24.2%（18.9-29.9%），30天总体和主要并发症发生率分别为15.9%（11.2-21.3%）和5.3%（3.3-7.8%）。对于治疗静脉曲张性GIB，NBCA注射是一种安全有效的方法，具有较高的技术成功率和极低的主要并发症发生率。
