Department of General Surgery, Shanxi Provincial Cancer Hosipital, Shanxi, China.
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Minim Invasive Ther Allied Technol. 2022 Oct;31(7):1017-1025. doi: 10.1080/13645706.2022.2111217. Epub 2022 Aug 24.
Topical hemostatic agents have been used to reduce bleeding rates after endoscopic submucosal dissection (ESD) for gastric cancer. However, to date, no review has summarized evidence on their efficacy.
PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar were searched for studies comparing bleeding rates after ESD with and without local hemostatic agents.
Eleven studies were included. The studies used polyglycolic acid (PGA) sheets and fibrin glue, fibrin glue, oxidized regenerated cellulose, polysaccharide hemostatic powder, or polyethylene oxide adhesive. Meta-analysis revealed a statistically significant reduction in the risk of delayed bleeding with the use of PGA sheets & fibrin glue (six studies; RR: 0.35 95% CI: 0.20, 0.63 = 0.0005). However, meta-analysis of two studies showed no difference in the risk of bleeding based on the use of fibrin glue (RR: 0.44 95% CI: 0.03, 7.17 = 0.56). Scarce data were available for the remaining hemostatic agents.
A large number of different hemostatic agents have been used to reduce the risk of bleeding after ESD for gastric cancer. Observational studies indicate that the use of PGA with fibrin glue could reduce the risk of bleeding after ESD. However, evidence for other agents was too scarce to derive conclusions.
局部止血剂已被用于降低胃癌内镜黏膜下剥离（ESD）后出血率。然而，迄今为止，尚无综述总结其疗效证据。
检索 PubMed、Embase、ScienceDirect、CENTRAL 和 Google Scholar，比较 ESD 术中应用与不应用局部止血剂的出血率。
共纳入 11 项研究。这些研究使用聚乙二醇酸（PGA）片和纤维蛋白胶、纤维蛋白胶、氧化再生纤维素、多糖止血粉或聚氧化乙烯粘合剂。Meta 分析显示，PGA 片联合纤维蛋白胶可显著降低延迟性出血风险（六项研究；RR：0.35，95%CI：0.20，0.63=0.0005）。然而，两项研究的 Meta 分析显示，纤维蛋白胶的使用与出血风险无差异（RR：0.44，95%CI：0.03，7.17=0.56）。其余止血剂的数据较少。
为降低胃癌 ESD 后出血风险，已使用大量不同的止血剂。观察性研究表明，PGA 联合纤维蛋白胶可降低 ESD 后出血风险。然而，其他药物的证据太少，无法得出结论。
