Saeed Aamir, Yousuf Saira, Gangwani Manesh Kumar, Aziz Muhammad, Ahmed Zohaib, Shah Janak, Farooq Umer, Kumar Anand, Schlachterman Alexander, Kowalski Thomas, Radlinski Mark, Gamboa Anthony, Kamal Faisal
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Division of Gastroenterology, University of Arkansas Medical Center, Little Rock, Arkansas, USA.
Gastrointest Endosc. 2025 Jun;101(6):1110-1117.e3. doi: 10.1016/j.gie.2024.12.023. Epub 2024 Dec 21.
Fully covered self-expandable metal stents (FCSEMSs) are often used in the management of postsphincterotomy bleeding that is refractory to conventional endoscopic treatments. In this meta-analysis, we evaluated the efficacy and safety of FCSEMSs in the management of postsphincterotomy bleeding.
We reviewed several databases from inception to November 6, 2024 to identify studies that evaluated the efficacy and/or safety of FCSEMSs in the management of postsphincterotomy bleeding. Our outcomes of interest were clinical success, recurrent bleeding, adverse events, stent migration, and pancreatitis. Subgroup analyses were performed by including studies in which FCSEMSs were used as a rescue treatment after failure of conventional endoscopic treatments. We calculated pooled rates with 95% confidence intervals (CIs) for our outcomes of interest. Data were analyzed using a random-effects model.
We included 7 studies with 224 patients. Pooled rates of clinical success were 95% (95% CI, 89-98), of recurrent bleeding were 7% (95% CI, 4-12), and of adverse events were 6% (95% CI, 2-16). Pooled rates of pancreatitis were 7% (95% CI, 2-19) and of stent migration were 10% (95% CI, 5-20). In most studies, FCSEMSs were used after failure of conventional endoscopic treatments, except in 2 studies in which FCSEMSs were used in some patients for primary treatment and in others after failure of conventional endoscopic treatments CONCLUSIONS: Our meta-analysis demonstrates the pooled efficacy and safety of FCSEMSs in the management of postsphincterotomy bleeding, especially as a rescue treatment in patients with persistent bleeding after conventional endoscopic treatments.
全覆膜自膨式金属支架（FCSEMSs）常用于治疗常规内镜治疗无效的括约肌切开术后出血。在这项荟萃分析中，我们评估了FCSEMSs治疗括约肌切开术后出血的疗效和安全性。
我们检索了从数据库建立至2024年11月6日的多个数据库，以确定评估FCSEMSs治疗括约肌切开术后出血疗效和/或安全性的研究。我们感兴趣的结局包括临床成功、再出血、不良事件、支架移位和胰腺炎。通过纳入将FCSEMSs用作常规内镜治疗失败后的挽救治疗的研究进行亚组分析。我们计算了感兴趣结局的合并率及95%置信区间（CIs）。数据采用随机效应模型进行分析。
我们纳入了7项研究，共224例患者。临床成功的合并率为95%（95%CI，89 - 98），再出血的合并率为7%（95%CI，4 - 12），不良事件的合并率为6%（95%CI，2 - 16）。胰腺炎的合并率为7%（95%CI，2 - 19），支架移位的合并率为10%（95%CI，5 - 20）。在大多数研究中，FCSEMSs是在常规内镜治疗失败后使用的，除了2项研究，其中一些患者将FCSEMSs用于初始治疗，另一些患者在常规内镜治疗失败后使用。结论：我们的荟萃分析表明FCSEMSs治疗括约肌切开术后出血具有总体疗效和安全性，尤其是作为常规内镜治疗后持续出血患者的挽救治疗。
