Jung Da Hyun, Yun Hae-Ryong, Lee Se Joon, Kim Na Won, Huh Cheal Wung
Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
J Clin Med. 2021 May 27;10(11):2346. doi: 10.3390/jcm10112346.
A transmural defect of the upper gastrointestinal (UGI) tract is a life-threatening condition associated with high morbidity and mortality. Recently, endoscopic vacuum therapy (EVT) was used for managing UGI defects and showed promising results. We conducted a systematic review and meta-analysis to synthesize evidence on the efficacy of EVT in patients with transmural defects of the UGI tract. We searched the PubMed, Cochrane Library, and Embase databases for publications on the effect of EVT on successful closure, mortality, complications, and post-EVT strictures. Methodological quality was assessed using the Newcastle-Ottawa quality assessment scale. This meta-analysis included 29 studies involving 498 participants. The pooled estimate rate of successful closure with EVT was 0.85 (95% confidence interval [CI]: 0.81-0.88). The pooled estimate rates for mortality, complications, and post-EVT strictures were 0.11, 0.10, and 0.14, respectively. According to the etiology of the transmural defect (perforation vs. leak and fistula), no significant difference was observed in successful closure (odds ratio [OR]: 1.45, 95% CI: 0.45-4.67, = 0.53), mortality (OR: 0.77, 95% CI: 0.24-2.46, = 0.66), complications (OR: 0.94, 95% CI: 0.17-5.15, = 0.94), or post-EVT stricture rates (OR: 0.70, 95% CI: 0.12-4.24, = 0.70). The successful closure rate was significantly higher with EVT than with self-expanding metal stent (SEMS) placement (OR: 3.14, 95% CI: 1.23-7.98, = 0.02). EVT is an effective and safe treatment for leaks and fistulae, as well as for perforations in the UGI. Moreover, EVT seems to be a better treatment option than SEMS placement for UGI defects.
上消化道（UGI）壁全层缺损是一种危及生命的疾病，具有较高的发病率和死亡率。最近，内镜下真空治疗（EVT）被用于治疗UGI缺损，并显示出了有前景的结果。我们进行了一项系统评价和荟萃分析，以综合关于EVT治疗UGI壁全层缺损患者疗效的证据。我们在PubMed、Cochrane图书馆和Embase数据库中搜索了关于EVT对成功闭合、死亡率、并发症和EVT后狭窄影响的出版物。使用纽卡斯尔-渥太华质量评估量表评估方法学质量。这项荟萃分析纳入了29项研究，涉及498名参与者。EVT成功闭合的合并估计率为0.85（95%置信区间[CI]：0.81-0.88）。死亡率、并发症和EVT后狭窄的合并估计率分别为0.11、0.10和0.14。根据壁全层缺损的病因（穿孔与渗漏和瘘管），在成功闭合（优势比[OR]：1.45，95%CI：0.45-4.67，P = 0.53）、死亡率（OR：0.77，95%CI：0.24-2.46，P = 0.66）、并发症（OR：0.94，95%CI：0.17-5.15，P = 0.94）或EVT后狭窄率（OR：0.70，95%CI：0.12-4.24，P = 0.70）方面未观察到显著差异。EVT的成功闭合率显著高于自膨式金属支架（SEMS）置入术（OR：3.14，95%CI：1.23-7.98，P = 0.02）。EVT是治疗UGI渗漏、瘘管以及穿孔的一种有效且安全的治疗方法。此外，对于UGI缺损，EVT似乎是比SEMS置入术更好的治疗选择。
