Department of Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, Utah, USA.
Department of Internal Medicine, University of Utah Health School of Medicine, Salt Lake City, Utah, USA.
Gastrointest Endosc. 2021 Dec;94(6):1021-1029.e10. doi: 10.1016/j.gie.2021.08.017. Epub 2021 Sep 1.
Gastric antral vascular ectasia (GAVE) is typically treated by endoscopic thermal therapies. Endoscopic band ligation (EBL) has been reported in the treatment of GAVE with encouraging results. However, EBL is not widely used to this end.
We conducted a comprehensive search of several databases (inception to May 2021) to identify studies reporting on the use of EBL in the treatment of GAVE. A random-effects model was used to calculate the pooled rates; I values and 95% prediction intervals were calculated to assess the heterogeneity.
Ten studies (194 patients) were included in the final analysis. The pooled rate of treatment responders with EBL in GAVE was 81% (95% confidence interval [CI], 62.2-91.7), and GAVE recurrence was 15.4% (95% CI, 4.5-41.3). The pooled mean number of treatment sessions required was 2.4 (95% CI, 2.2-2.7), and the number of bands used to achieve eradication per patient was 15.1 (95% CI, 10.7-19.4). The pooled mean difference of pre- to post-treatment hemoglobin was 1.5 (95% CI, .9-2.2; P = .001), pre- to post-treatment units of packed red blood cells transfused was 1.1 (95% CI, .4-1.9; P = .002), and pre- to post-treatment hospital length of stay was .5 days (95% CI, .1-.9; P = .01). The pooled rate of overall adverse events was 15.9% (95% CI, 10.4-23.7).
EBL demonstrated excellent clinical outcomes in the treatment of GAVE with minimal adverse events. Multicenter randomized controlled trials comparing EBL and other modalities as initial therapy are warranted.
胃底腺血管扩张症（GAVE）通常采用内镜热疗进行治疗。有报道称，内镜套扎（EBL）治疗 GAVE 效果令人鼓舞，但并未广泛应用于该疾病。
我们对多个数据库（从创建到 2021 年 5 月）进行了全面检索，以确定报道 EBL 治疗 GAVE 的研究。采用随机效应模型计算汇总率；采用 I ²值和 95%预测区间评估异质性。
最终分析纳入 10 项研究（194 例患者）。EBL 治疗 GAVE 的应答率为 81%（95%置信区间[CI]，62.2%-91.7%），GAVE 复发率为 15.4%（95%CI，4.5%-41.3%）。汇总的平均治疗次数为 2.4 次（95%CI，2.2-2.7），每位患者使用的套扎圈数为 15.1 个（95%CI，10.7-19.4）。治疗前后血红蛋白的平均差值为 1.5g/dL（95%CI，0.9-2.2；P=0.001），治疗前后输注的浓缩红细胞单位数平均差值为 1.1 个单位（95%CI，0.4-1.9；P=0.002），治疗前后的住院时间平均差值为 0.5 天（95%CI，0.1-0.9；P=0.01）。总的不良事件发生率为 15.9%（95%CI，10.4%-23.7%）。
EBL 治疗 GAVE 效果显著，不良事件发生率低。需要开展多中心随机对照试验，比较 EBL 与其他治疗方法作为初始治疗的效果。
