聚乙二醇酸片在内镜黏膜下剥离术后胃肠道出血和食管狭窄管理中的作用：一项符合 PRISMA 标准的系统评价和荟萃分析。

The role of polyglycolic acid sheets in the management of post-endoscopic submucosal dissection gastrointestinal bleeding and esophageal stricture: A PRISMA compliant systematic review and meta-analysis.

机构信息

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China.

Department of Gastroenterology, Chongqing University Three Gorges Hospital, Chongqing, China.

出版信息

Medicine (Baltimore). 2022 Jul 1;101(26):e29770. doi: 10.1097/MD.0000000000029770.

DOI:10.1097/MD.0000000000029770

PMID:35776992

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9239659/

Abstract

BACKGROUND

As a relatively minimally invasive technique, endoscopic submucosal dissection (ESD) is widely used for the treatment of gastrointestinal lesions. However, it is associated with complications, such as postoperative bleeding, stricture, and perforation. A covering method using polyglycolic acid (PGA) sheets for ESD-induced ulcers has been reported to be effective in reducing the risk of post-ESD bleeding and esophageal stricture. Herein, we conducted a systematic review and meta-analysis to evaluate the role of PGA sheets in the prevention of gastrointestinal bleeding and esophageal stricture after ESD.

METHODS

We searched PubMed, Web of Science, and the Cochrane Library databases on October 15, 2019. All eligible articles were selected based on the predefined inclusion and exclusion criteria. The main outcomes were the rates of post-ESD gastrointestinal bleeding and esophageal stricture. Cochrane's Q statistic and I2 test were used to identify heterogeneity between the studies. When there was no obvious heterogeneity (I2 < 50%, P > .1), a fixed-effect model was used. When there was obvious heterogeneity (I2 > 50%, P < .1), a random effect model was used. Funnel plots and the Egger regression test were used to assess publication bias.

RESULTS

Fifteen articles were included in the meta-analysis, of which 7 were exclusively about the use of PGA sheets to prevent postoperative gastrointestinal bleeding, and the remaining reported the use of PGA sheets to prevent postoperative esophageal stenosis. Our analysis showed that preventive therapy with PGA sheets decreased the rates of post-ESD gastrointestinal bleeding (risk ratio [RR] = 0.35, 95% confidential interval [CI]: 0.19-0.64, P < .001) and esophageal stricture (RR = 0.46, 95% CI: 0.27-0.79, P = .005), and the gastrointestinal bleeding and esophageal stricture rates after preventive treatment with PGA sheets were 5.7% (95% CI: 3.6%-8.8%) and 20.6% (95% CI: 14.5%-28.4%), respectively.

CONCLUSION

The utilization of PGA sheets after ESD has an excellent outcome in reducing the risk of postoperative gastrointestinal bleeding and esophageal stricture.

摘要

背景

内镜黏膜下剥离术（ESD）作为一种相对微创的技术，被广泛应用于胃肠道病变的治疗。然而，它也伴随着一些并发症，如术后出血、狭窄和穿孔。有报道称，使用聚乙二醇酸（PGA）片覆盖ESD 诱导的溃疡可有效降低术后出血和食管狭窄的风险。在此，我们进行了一项系统评价和荟萃分析，以评估 PGA 片在预防 ESD 后胃肠道出血和食管狭窄中的作用。

方法

我们于 2019 年 10 月 15 日检索了 PubMed、Web of Science 和 Cochrane 图书馆数据库。根据预先设定的纳入和排除标准，选择所有符合条件的文章。主要结局指标为 ESD 后胃肠道出血和食管狭窄的发生率。采用 Cochrane's Q 统计量和 I2 检验来评估研究间的异质性。当无明显异质性（I2<50%，P>.1）时，采用固定效应模型；当存在明显异质性（I2>50%，P<.1）时，采用随机效应模型。采用漏斗图和 Egger 回归检验评估发表偏倚。

结果

荟萃分析纳入了 15 篇文章，其中 7 篇专门探讨了 PGA 片预防术后胃肠道出血的作用，其余报道了 PGA 片预防术后食管狭窄的作用。我们的分析表明，PGA 片预防治疗可降低 ESD 后胃肠道出血的发生率（风险比[RR]=0.35，95%置信区间[CI]：0.19-0.64，P<.001）和食管狭窄的发生率（RR=0.46，95%CI：0.27-0.79，P=0.005），PGA 片预防治疗后胃肠道出血和食管狭窄的发生率分别为 5.7%（95%CI：3.6%-8.8%）和 20.6%（95%CI：14.5%-28.4%）。