Huang Gang, Tian Feng-Yu, An Wen, Ai Li-Si, Yu Yan-Bo
Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China.
Endosc Int Open. 2022 Jun 10;10(6):E865-E873. doi: 10.1055/a-1793-9479. eCollection 2022 Jun.
Bleeding is a common complication of following endoscopy sphincterotomy (EST), and antithrombotic therapy use during the procedure often increases risk of it. Although several guidelines have been released regarding the use of antithrombotic agents during EST, many issues about it remain controversial. We carried out a systematic review and meta-analysis to evaluate the effect of antithrombotic medication on the risk of EST bleeding. A structured literature search was carried out in Web of Science, EMBASE, PubMed, and Cochrane Library databases. RevMan 5.2 was used for meta-analysis to investigate the rate of post-EST bleeding. Seven retrospective articles were included. Compared with patients who had never taken antithrombotic drugs, patients who discontinued antithrombotic drugs 1 day before the procedure had a significantly increased risk of post-EST bleeding (OR, 1.95; 95 %CI, 1.57-2.43), particularly for severe bleeding (OR, 1.83; 95 %CI, 1.44-2.34). In addition, compared with patients who discontinued antithrombotic therapy for at least 1 day, patients who continued taking antithrombotic drugs did have an increased risk of post-EST bleeding (OR, 0.70; 95 %CI, 0.40-1.23). The use of antithrombotic drugs may increase the bleeding rate of EST, but discontinuing therapy 1 day before endoscopy does not significantly reduce the bleeding rate.
出血是内镜下括约肌切开术（EST）后的常见并发症，术中使用抗血栓治疗往往会增加出血风险。尽管已经发布了多项关于EST期间使用抗血栓药物的指南，但关于这方面的许多问题仍存在争议。我们进行了一项系统评价和荟萃分析，以评估抗血栓药物对EST出血风险的影响。在科学网、EMBASE、PubMed和Cochrane图书馆数据库中进行了结构化文献检索。使用RevMan 5.2进行荟萃分析，以研究EST后出血率。纳入了7篇回顾性文章。与从未服用过抗血栓药物的患者相比，在手术前1天停用抗血栓药物的患者EST后出血风险显著增加（OR，1.95；95%CI，1.57-2.43），尤其是严重出血（OR，1.83；95%CI，1.44-2.34）。此外，与至少停用抗血栓治疗1天的患者相比，继续服用抗血栓药物的患者EST后出血风险确实增加（OR，0.70；95%CI，0.40-1.23）。使用抗血栓药物可能会增加EST的出血率，但在内镜检查前1天停药并不能显著降低出血率。
