Bapaye Jay, Chandan Saurabh, Naing Le Yu, Shehadah Ahmed, Deliwala Smit, Bhalla Varun, Chathuranga Dileepa, Okolo Patrick I
Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA.
Division of Gastroenterology, CHI Health Creighton University Medical Center, Omaha, Nebraska, USA.
Gastrointest Endosc. 2022 Nov;96(5):712-720.e7. doi: 10.1016/j.gie.2022.06.032. Epub 2022 Jul 5.
Upper GI bleeding (UGIB) is a common condition associated with significant morbidity and mortality. Endoscopic hemostasis remains the mainstay of therapy and is mainly aimed at effective hemostasis and prevention of rebleeding. Lesions with high-risk stigmata can have rebleeding rates of as high as 26.3%. Rebleeding is associated with increased mortality and reduced success rates of endoscopic retreatment. The over-the-scope-clip (OTSC) is a device with widespread endoscopic indications including hemostasis for nonvariceal UGIB (NVUGIB). The current study presents a systematic review and meta-analysis comparing OTSCs versus standard therapy (STD) for NVUGIB.
Multiple databases were searched through April 2022 for studies comparing OTSCs and STD for NVUGIBs. Primary outcomes were clinical success rates, rebleeding rates, and procedure times, and secondary outcomes were mortality rates and length of hospitalization. Meta-analysis was performed to determine pooled odds ratios to compare outcomes between the OTSC and STD groups.
Ten studies, including 4 randomized controlled trials, with 914 patients were included in the final analysis. Of patients with NVUGIB, 431 were treated with OTSCs and 483 with STD. Patients treated with OTSCs had an overall lower risk of 7-day (risk ratio [RR], .41; 95% confidence interval [CI], .24-.68; I = 0%) and 30-day rebleeding (RR, .46; 95% CI, .31-.65; I = 0%). Clinical success rates were higher with OTSCs compared with STD (RR, 1.36; 95% CI, 1.06-1.75). Mean procedure time was shorter in the OTSC group by 6.62 minutes (95% CI, 2.58-10.67) versus the STD group (I = 84%). There was no statistically significant difference in terms of mortality between the OTSC and STD groups (RR, .55; 95% CI, .24-1.24; I = 0%). Length of hospitalization was comparable between both groups, with a pooled mean difference for OTSCs versus STD of .87 days (95% CI, -1.62 to 3.36 days; I = 71%).
Although our study was limited to high-risk NVUGIB, our analysis showed that hemostasis with OTSCs is associated with a lower 7-day and 30-day rebleeding rates, higher clinical success rates, and shorter procedure time with similar mortality rates and length of hospital stay as compared with STD.
上消化道出血（UGIB）是一种常见疾病，具有较高的发病率和死亡率。内镜止血仍然是主要的治疗方法，主要目标是实现有效止血并预防再出血。具有高危特征的病变再出血率可高达26.3%。再出血与死亡率增加以及内镜再治疗成功率降低相关。全层吻合夹（OTSC）是一种具有广泛内镜应用指征的器械，包括用于非静脉曲张性上消化道出血（NVUGIB）的止血。本研究进行了一项系统评价和荟萃分析，比较OTSC与标准治疗（STD）用于NVUGIB的疗效。
检索多个数据库至2022年4月，查找比较OTSC与STD治疗NVUGIB的研究。主要结局指标为临床成功率、再出血率和操作时间，次要结局指标为死亡率和住院时间。进行荟萃分析以确定合并比值比，比较OTSC组和STD组的结局。
最终分析纳入了10项研究，包括4项随机对照试验，共914例患者。在NVUGIB患者中，431例接受OTSC治疗，483例接受STD治疗。接受OTSC治疗的患者7天（风险比[RR]，0.41；95%置信区间[CI]，0.24 - 0.68；I² = 0%）和30天再出血的总体风险较低（RR，0.46；95% CI，0.31 - 0.65；I² = 0%）。与STD相比，OTSC的临床成功率更高（RR，1.36；95% CI，1.06 - 1.75）。OTSC组的平均操作时间比STD组短6.62分钟（95% CI，2.58 - 10.67）（I² = 84%）。OTSC组和STD组之间的死亡率无统计学显著差异（RR，0.55；95% CI，0.24 - 1.24；I² = 0%）。两组的住院时间相当，OTSC与STD的合并平均差异为0.87天（95% CI，-1.62至3.36天；I² = 71%）。
尽管我们的研究仅限于高危NVUGIB，但我们的分析表明，与STD相比，OTSC止血与7天和30天再出血率较低、临床成功率较高、操作时间较短相关，且死亡率和住院时间相似。
