Department of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, Utah, USA.
Department of Gastroenterology, Caritas Hospital, Kottayam, Kerala, India.
Gastrointest Endosc. 2022 Jun;95(6):1060-1066.e7. doi: 10.1016/j.gie.2022.01.018. Epub 2022 Feb 3.
Use of hydrogen peroxide (HO) has been reported in direct endoscopic necrosectomy (DEN) of pancreatic walled-off necrosis (WON). The aim of this meta-analysis was to study the pooled clinical outcomes of HO-assisted DEN of pancreatic WON.
We conducted a comprehensive search of several databases (inception to July 2021) to identify studies reporting on the use of HO in DEN of WON. A random-effects model was used to calculate pooled rates and I values, and 95% prediction intervals were used to assess heterogeneity. The outcomes studied were technical success, clinical success, and adverse events in HO-assisted DEN of pancreatic WON.
In 7 analyzed studies, 186 patients underwent HO-assisted DEN of WON. The pooled rate of technical success was 95.8% (95% confidence interval [CI], 88.5-98.5), clinical success was 91.6% (95% CI, 86.1-95), and cumulative rate of overall adverse events was 19.3% (95% CI, 7.6-41). The pooled rate of bleeding was 7.9% (95% CI, 2.4-22.7), stent migration was 11.3% (95% CI, 4.9-23.9), perforation 5.4% (95% CI, 1.7-15.7), infection 5.7% (95% CI, 2-15.1), and pulmonary adverse event 2.9% (95% CI, 1.3-6.1). Mean treatment sessions ranged from 2 to 5.
HO-assisted DEN of WON demonstrated excellent clinical outcomes, with minimal heterogeneity. No adverse events attributable to HO were reported. Future controlled studies are warranted comparing the clinical outcomes with and without HO before HO use can be established in DEN of pancreatic WON.
过氧化氢（HO）已被报道用于内镜下坏死组织清除术（DEN）治疗胰腺包裹性坏死（WON）。本荟萃分析的目的是研究 HO 辅助 DEN 治疗胰腺 WON 的临床结局。
我们对多个数据库（从建库到 2021 年 7 月）进行了全面检索，以确定报告 HO 用于 DEN 治疗 WON 的研究。采用随机效应模型计算合并率和 I ²值，95%预测区间用于评估异质性。研究的结局包括 HO 辅助 DEN 治疗胰腺 WON 的技术成功率、临床成功率和不良事件。
在分析的 7 项研究中，186 例患者接受了 HO 辅助 DEN 治疗 WON。技术成功率的合并率为 95.8%（95%置信区间 [CI]，88.5-98.5），临床成功率为 91.6%（95% CI，86.1-95），总体不良事件发生率为 19.3%（95% CI，7.6-41）。出血的合并率为 7.9%（95% CI，2.4-22.7），支架迁移率为 11.3%（95% CI，4.9-23.9），穿孔率为 5.4%（95% CI，1.7-15.7），感染率为 5.7%（95% CI，2-15.1），肺部不良事件发生率为 2.9%（95% CI，1.3-6.1）。治疗次数从 2 次到 5 次不等。
HO 辅助 DEN 治疗 WON 显示出极好的临床结局，异质性较小。未报告归因于 HO 的不良事件。在 HO 可用于 DEN 治疗胰腺 WON 之前，需要进行比较 HO 与不使用 HO 的临床结局的对照研究。
