超声内镜引导下治疗胃静脉曲张的一级和二级预防——一项最新的系统评价和荟萃分析
EUS-guided therapies for primary and secondary prophylaxis in gastric varices-An updated systematic review and meta-analysis.
作者信息
Chandan Saurabh, Nguyen Andrew Khoi, Mohan Babu P, Deliwala Smit, Ramai Daryl, Kassab Lena L, Muthusamy Arunkumar, Facciorusso Antonio, Kamal Faisal, Bilal Mohammad, Samanta Jayanta, Adler Douglas G
机构信息
Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA.
Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
出版信息
Endosc Ultrasound. 2023 Jul-Aug;12(4):351-361. doi: 10.1097/eus.0000000000000017. Epub 2023 Sep 13.
BACKGROUND AND OBJECTIVES
Gastric varices (GVs) are associated with a higher risk of uncontrolled bleeding and death when compared with esophageal varices. While endoscopic glue injection therapy has been traditionally used for secondary prophylaxis in GV, data regarding primary prophylaxis continue to emerge. Recently, EUS-guided therapies have been used in GV bleeding.
METHODS
We conducted a comprehensive search of several major databases from inception to June 2022. Our primary goals were to estimate the pooled rates of treatment efficacy, GV obliteration, GV recurrence, and rebleeding with EUS-guided therapy in primary and secondary prophylaxis. Overall adverse events and technical failures were assessed. Random-effects model was used for our meta-analysis, and heterogeneity was assessed using the % statistics.
RESULTS
Eighteen studies with 604 patients were included. In primary prophylaxis, pooled rate of GV obliteration was 90.2% (confidence interval [CI], 81.1-95.2; = 0). With combination EUS-glue and coil therapy, the rate was 95.4% (CI, 86.7%-98.5%; = 0). Pooled rate of posttherapy GV bleeding was 4.9% (CI, 1.8%-12.4%; = 0). In secondary prophylaxis, pooled rate of treatment efficacy was 91.9% (CI, 86.8%-95.2%; = 12). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 94.3% (CI, 88.9%-97.1%; = 0), 95.5% (CI, 80.3%-99.1%; = 0), and 88.7% (CI, 76%-95.1%; = 14), respectively. Pooled rate of GV obliteration was 83.6% (CI, 71.5%-91.2%; = 74). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 84.6% (CI, 75.9%-90.6%; = 31), 92.3% (CI, 81.1%-97.1%; = 0), and 84.5% (CI, 50.8%-96.7%; = 75), respectively. Pooled rates of GV rebleeding and recurrence were 18.1% (CI, 13.1%-24.3%; = 16) and 20.6% (CI, 9.3%-39.5%; = 66), respectively.
CONCLUSION
Our analysis shows that EUS-guided therapy for GVs is technically feasible and clinically successful in both primary and secondary prophylaxis of GV.
背景与目的
与食管静脉曲张相比，胃静脉曲张（GVs）发生难以控制的出血及死亡的风险更高。虽然内镜下注射胶水治疗传统上一直用于GV的二级预防，但关于一级预防的数据仍在不断涌现。最近，超声内镜引导下的治疗已用于GV出血。
方法
我们对几个主要数据库从创建到2022年6月进行了全面检索。我们的主要目标是评估超声内镜引导下治疗在一级和二级预防中的治疗效果、GV闭塞、GV复发及再出血的合并发生率。评估了总体不良事件和技术失败情况。我们的荟萃分析采用随机效应模型，并使用I²统计量评估异质性。
结果
纳入了18项研究，共604例患者。在一级预防中，GV闭塞的合并发生率为90.2%（置信区间[CI]，81.1%-95.2%；I² = 0）。采用超声内镜-胶水联合线圈治疗时，该发生率为95.4%（CI，86.7%-98.5%；I² = 0）。治疗后GV出血的合并发生率为4.9%（CI，1.8%-12.4%；I² = 0）。在二级预防中，治疗效果的合并发生率为91.9%（CI，86.8%-95.2%；I² = 12）。采用超声内镜-胶水、超声内镜-线圈以及超声内镜-胶水联合线圈治疗时，发生率分别为94.3%（CI，88.9%-97.1%；I² = 0）、95.5%（CI，80.3%-99.1%；I² = 0）和88.7%（CI，76%-95.1%；I² = 14）。GV闭塞的合并发生率为83.6%（CI，71.5%-91.2%；I² = 74）。采用超声内镜-胶水、超声内镜-线圈以及超声内镜-胶水联合线圈治疗时，发生率分别为84.6%（CI，75.9%-90.6%；I² = 31）、92.3%（CI，81.1%-97.1%；I² = 0）和84.5%（CI，50.8%-96.7%；I² = 75）。GV再出血和复发的合并发生率分别为18.1%（CI，13.1%-24.3%；I² = 16）和20.6%（CI，9.3%-39.5%；I² = 66）。
结论
我们的分析表明，超声内镜引导下治疗GV在GV的一级和二级预防中技术上可行且临床效果良好。
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