Kogilathota Jagirdhar Gowthami Sai, Perez Jose Andres, Banga Akshat, Qasba Rakhtan K, Qasba Ruman K, Pattnaik Harsha, Hussain Muhammad, Bains Yatinder, Surani Salim
Department of Medicine, Saint Francis Health Science Center, Newark, NJ 07107, United States.
Department of Medicine, Saint Francis Health Systems, Tulsa, OK 74133, United States.
World J Gastrointest Endosc. 2024 Apr 16;16(4):214-226. doi: 10.4253/wjge.v16.i4.214.
Second-look endoscopy (SLE) to prevent recurrent bleeding in patients with peptic ulcer disease (PUD) and those undergoing endoscopic submucosal dissection (ESD) is routinely being performed. Conflicting evidence exists regarding efficacy, risk, benefit, and cost-effectiveness.
To identify the role and effectiveness of SLE in ESD and PUD, associated rebleeding and PUD-related outcomes like mortality, hospital length of stay, need for endoscopic or surgical intervention and blood transfusions.
A systematic review of literature databases PubMed, Cochrane, and Embase was conducted from inception to January 5, 2023. Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included. The study was conducted per PRISMA guidelines, and the protocol was registered in PROSPERO (ID CRD42023427555:). RevMan was used to perform meta-analysis, and Mantel-Haenszel Odds ratio (OR) were generated using random effect models.
A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis, of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding. In ESD, the rates of rebleeding were 7% in the SLE group compared to 4.4% in the non-SLE group with OR 1.65, 95% confidence intervals (CI) of 0.96 to 2.85; = 0.07, whereas it was 11% in the SLE group compared to 13% in the non-SLE group with OR 0.8 95%CI: 0.50 to 1.29; = 0.36. The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01, 95%CI: -0.22 to 0.25; = 0.91. In SLE non-SLE groups with PUD, the OR for Endoscopic intervention was 0.29, 95%CI: 0.08 to 1.00; = 0.05 while it was OR 2.03, 95%CI: 0.95 to 4.33; = 0.07, for surgical intervention. The mean difference in the hospital length of stay was -3.57 d between the SLE and no SLE groups in PUD with 95%CI: -7.84 to 0.69; = 0.10, denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE. For mortality between SLE and non-SLE groups in PUD, the OR was 0.88, 95%CI: 0.45 to 1.72; = 0.70.
SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding. SLE also does not provide any significant improvement in mortality, need for interventions, or blood transfusions in PUD patients. SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.
目前常规进行二次内镜检查（SLE）以预防消化性溃疡疾病（PUD）患者及接受内镜黏膜下剥离术（ESD）患者的复发性出血。关于其疗效、风险、益处和成本效益，存在相互矛盾的证据。
确定SLE在ESD和PUD中的作用及有效性，以及相关的再出血情况和PUD相关结局，如死亡率、住院时间、内镜或手术干预需求及输血情况。
对文献数据库PubMed、Cochrane和Embase进行系统回顾，检索时间从数据库建立至2023年1月5日。纳入比较SLE患者与未进行SLE患者的随机对照试验，或评估SLE期间预防性止血与其他保守干预措施相比作用的研究。研究按照PRISMA指南进行，方案已在PROSPERO注册（ID CRD42023427555）。使用RevMan进行荟萃分析，采用随机效应模型生成Mantel-Haenszel优势比（OR）。
我们的系统回顾和荟萃分析共纳入12项研究，涉及2687例患者，其中1074例患者在ESD后接受SLE，1613例患者在PUD相关出血后接受SLE。在ESD中，SLE组的再出血率为7%，非SLE组为4.4%，OR为1.65，9⁵%置信区间（CI）为0.96至2.85；P = 0.07，而SLE组为11%，非SLE组为13%，OR为0.8，95%CI：0.50至1.29；P = 0.36。PUD中SLE组和非SLE组输血率的平均差异OR为0.01，95%CI：-0.22至0.25；P = 0.91。在PUD的SLE与非SLE组中，内镜干预的OR为0.29，95%CI：0.08至1.00；P = 0.05，而手术干预的OR为2.03，95%CI：0.95至4.33；P = 0.07。PUD中SLE组和非SLE组的住院时间平均差异为-3.57天，95%CI：-7.84至0.69；P = 0.10，这表明接受SLE的PUD患者平均住院天数约少3天。PUD中SLE组和非SLE组的死亡率OR为0.88，95%CI：0.45至1.72；P = 0.70。
SLE在预防ESD和PUD相关再出血方面无任何益处。SLE在PUD患者的死亡率、干预需求或输血方面也未带来任何显著改善。SLE使PUD患者的平均住院时间缩短3.5天。
