Chen Youli, Zhao Xinyan, Wang Dongke, Liu Xinghuang, Chen Jie, Song Jun, Bai Tao, Hou Xiaohua
Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Spleen and Stomach Disease, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430006, China.
Polymers (Basel). 2022 Jun 13;14(12):2387. doi: 10.3390/polym14122387.
New endoscopic approaches for the prevention of delayed bleeding (DB) after gastric endoscopic submucosal dissection (ESD) have been reported in recent years, and endoscopic delivery of biodegradable polymers for iatrogenic ulcer hemostasis and coverage has emerged as one of the most promising techniques for post-ESD management. However, the comparative efficacy of these techniques remains uncertain. We performed a systematic search of multiple databases up to May 2022 to identify studies reporting DB rates as outcomes in patients undergoing gastric ESD who were treated with subsequent endoscopic management, including endoscopic closure (clip-based methods and suturing), PGA sheet tissue shielding, and hemostatic powder/gel spray (including polymeric sealants and other adhesives). The risk ratios (RRs) of delayed bleeding in treatment groups and control groups were pooled, and the Bayesian framework was used to perform a network meta-analysis (NMA). Among these studies, 16 head-to-head comparisons that covered 2742 lesions were included in the NMA. Tissue shielding using PGA sheets significantly reduced the risk of DB by nearly two thirds in high-risk patients, while hemostatic spray systems, primarily polymer-based, reduced DB in low-risk patients nine-fold. Researchers should recognize the essential role of polymers in the management of ESD-induced ulcers, and develop and validate clinical application strategies for promising materials.
近年来，已有关于预防胃内镜黏膜下剥离术（ESD）后迟发性出血（DB）的新内镜方法的报道，并且内镜下递送可生物降解聚合物用于医源性溃疡止血和覆盖已成为ESD术后管理中最有前景的技术之一。然而，这些技术的相对疗效仍不确定。我们对截至2022年5月的多个数据库进行了系统检索，以确定报告接受后续内镜管理（包括内镜闭合（夹子法和缝合）、聚乙醇酸（PGA）片组织屏蔽以及止血粉/凝胶喷雾（包括聚合物密封剂和其他粘合剂））的胃ESD患者中DB发生率作为结局的研究。汇总治疗组和对照组迟发性出血的风险比（RRs），并使用贝叶斯框架进行网状荟萃分析（NMA）。在这些研究中，NMA纳入了16项涉及2742个病变的直接比较。使用PGA片进行组织屏蔽在高危患者中显著降低了近三分之二的DB风险，而主要基于聚合物的止血喷雾系统在低危患者中使DB风险降低了9倍。研究人员应认识到聚合物在ESD诱导溃疡管理中的重要作用，并开发和验证有前景材料的临床应用策略。
