Delaleeuwe Isha, Aoun Jennifer, Reynaert Hendrik, Gkolfakis Paraskevas, Eisendrath Pierre
Department of Hepatology and Gastroenterology, UZ Brussel, Jette, Belgium (Isha Delaleeuwe, Hendrik Reynaert).
Department of Hepatology and Gastroenterology, CHU Saint-Pierre, Brussels, Belgium (Jennifer Aoun, Pierre Eisendrath).
Ann Gastroenterol. 2025 Jan-Feb;38(1):41-50. doi: 10.20524/aog.2025.0940. Epub 2024 Dec 23.
Various endoscopic treatment options are available for managing colonic diverticular bleeding (CDB). We conducted a systematic review and meta-analysis to assess the effectiveness of these endoscopic interventions in achieving hemostasis in patients with CDB, focusing on early rebleeding rate (ERR) within 30 days.
A systematic literature search of the PubMed and Cochrane Library databases was performed for articles published between January 2008 and December 2023. Studies evaluating endoscopic clipping, with or without epinephrine injection, endoscopic band ligation (EBL) and endoscopic snare ligation (EDSL) in the treatment of CDB were included. The primary outcome was the overall pooled ERR following successful hemostasis. Secondary outcomes addressed ERRs associated with various hemostatic endoscopic techniques, and pooled ERRs for both direct and indirect clipping methods. Results are presented as pooled rates and odds ratio (OR) with 95% confidence intervals (CI).
Sixteen studies were included, comprising 1435 patients with definite CDB of whom 1273 received endoscopic hemostatic treatment. Overall pooled ERR was 14.73% (95%CI 9.33-20.14%). Pooled ERRs were 9.83% (95%CI 7.41-12.26%) in the EBL/EDSL group and 22.32% (95%CI 12.48-32.16%) in the endoscopic clipping group (P=0.02). A subgroup analysis of the clipping group showed a significant difference between the pooled ERRs favoring direct clipping: 12.04% (95%CI 3.06-21.02%) vs. 27.74% (95%CI 18.34-37.14%), P=0.02. The measured effect favors direct over indirect clipping in reducing early rebleeding episodes: OR 0.45, 95%CI 0.24-0.85; P=0.01.
In the management of patients presenting with CDB, EBL/EDSL and direct clipping showed significantly lower ERRs compared to indirect clipping.
有多种内镜治疗方法可用于处理结肠憩室出血（CDB）。我们进行了一项系统评价和荟萃分析，以评估这些内镜干预措施在实现CDB患者止血方面的有效性，重点关注30天内的早期再出血率（ERR）。
对2008年1月至2023年12月发表的文章在PubMed和Cochrane图书馆数据库中进行系统的文献检索。纳入评估内镜夹闭（无论是否联合肾上腺素注射）、内镜套扎术（EBL）和内镜圈套结扎术（EDSL）治疗CDB的研究。主要结局是成功止血后的总体合并ERR。次要结局涉及与各种内镜止血技术相关的ERR，以及直接和间接夹闭方法的合并ERR。结果以合并率和比值比（OR）及95%置信区间（CI）表示。
纳入16项研究，共1435例确诊CDB患者，其中1273例接受了内镜止血治疗。总体合并ERR为14.73%（95%CI 9.33 - 20.14%）。EBL/EDSL组的合并ERR为9.83%（95%CI 7.41 - 12.26%），内镜夹闭组为22.32%（95%CI 12.48 - 32.16%）（P = 0.02）。夹闭组的亚组分析显示，合并ERR在直接夹闭方面存在显著差异：12.04%（95%CI 3.06 - 21.02%）对27.74%（95%CI 18.34 - 37.14%），P = 0.02。在减少早期再出血事件方面，直接夹闭的效果优于间接夹闭：OR 0.45，95%CI 0.24 - 0.85；P = 0.01。
在处理CDB患者时，与间接夹闭相比，EBL/EDSL和直接夹闭的ERR显著更低。
