Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA.
Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd, Las Vegas, NV, 89102, USA.
Dig Dis Sci. 2023 Sep;68(9):3694-3701. doi: 10.1007/s10620-023-08009-w. Epub 2023 Jul 5.
Gastrointestinal bleeding (GIB) is a common and potentially fatal condition with all-cause mortality ranging from 3 to 10%. Endoscopic therapy traditionally involves mechanical, thermal, and injection therapies. Recently, self-assembling peptide (SAP) has become increasingly available in the United States. When applied to an affected area, this gel forms an extracellular matrix-type structure allowing for hemostasis. This is the first systematic review and meta-analysis to assess the safety and efficacy of this modality in GIB.
We performed a comprehensive literature search of major databases from inception to Nov 2022. The primary outcomes assessed were the success of hemostasis, rebleeding rates, and adverse events. The secondary outcomes assessed were successful hemostasis with monotherapy with SAP and combined therapy, which may include mechanical, injection, and thermal therapies. Pooled estimates were calculated using random-effects models with a 95% confidence interval (CI).
The analysis included 7 studies with 427 patients. 34% of the patients were on anticoagulation or antiplatelet agents. SAP application was technically successful in all patients. The calculated pooled rate of successful hemostasis was 93.1% (95% confidence interval (CI) 84.7-97.0, I = 73.6), and rebleeding rates were 8.9% (95% CI 5.3-14.4, I = 55.8). The pooled rates of hemostasis with SAP monotherapy and combined therapy were similar. No adverse events were noted related to SAP.
SAP appears to be a safe and effective treatment modality for patients with GIB. This modality provides an added advantage of improved visualization over the novel spray-based modalities. Further, prospective, or randomized controlled trials are needed to validate our findings.
胃肠道出血（GIB）是一种常见且潜在致命的疾病，其全因死亡率为 3%至 10%。传统的内镜治疗包括机械、热和注射治疗。最近，自组装肽（SAP）在美国越来越普及。当应用于受影响的区域时，这种凝胶会形成一种细胞外基质样结构，从而实现止血。这是首次系统评价和荟萃分析，评估该方法在 GIB 中的安全性和疗效。
我们对主要数据库进行了全面的文献检索，检索时间从开始到 2022 年 11 月。主要评估指标为止血成功率、再出血率和不良事件。次要评估指标为 SAP 单药和联合治疗的止血成功率，联合治疗可能包括机械、注射和热治疗。使用随机效应模型计算合并估计值，并计算 95%置信区间（CI）。
分析纳入了 7 项研究，共 427 例患者。34%的患者正在服用抗凝或抗血小板药物。所有患者的 SAP 应用均在技术上取得成功。计算得出的止血成功率合并率为 93.1%（95%CI 84.7-97.0，I=73.6），再出血率为 8.9%（95%CI 5.3-14.4，I=55.8）。SAP 单药和联合治疗的止血成功率相似。未观察到与 SAP 相关的不良事件。
SAP 似乎是治疗 GIB 患者的一种安全有效的治疗方法。与新型喷雾式治疗方法相比，这种方法具有改善可视化的额外优势。需要进一步开展前瞻性或随机对照试验来验证我们的研究结果。
