食管静脉曲张侧支循环可预测内镜治疗后复发和再出血:系统综述和meta分析

Esophageal collateral veins in predicting esophageal variceal recurrence and rebleeding after endoscopic treatment:a systematic review and meta-analysis

背景:内镜治疗被推荐应用于食管静脉曲张,但内镜根治后常出现静脉曲张复发或再出血。本研究旨在系统评估食管静脉曲张侧支静脉循环(ECV)的出现率以及ECV与内镜治疗后复发或再出血的关系。方法:我们通过PubMed、EMBASE和Cochrane等数据库检索相关文献。统计食管旁静脉(para-EV)、食管周围静脉(peri-EV)和穿静脉(PV)的出现率。分别采用风险比(RR)和比值比(OR)对队列研究和病例对照研究的复发/再出血风险进行评估。采用随机效应模型进行合并分析,并评估研究间的异质性。结果:提取的532篇文献最终纳入28篇进行分析。合并分析显示,食管静脉曲张患者para-EV、peri-EV和PV的出现率分别为73%、88%和54%。静脉曲张复发患者para-EV和PV的出现率分别为87%和62%。PV患者食管静脉曲张复发率显著升高(8项病例对照研究合并分析:OR=9.79,95%CI:1.95-49.22,P=0.006),但para-EV患者复发率未见显著升高(4项病例对照研究合并分析:OR=4.26,95%CI:0.38-38.35,P=0.24;3项队列研究合并分析:RR=1.81,95%CI:0.83-3.97,P=0.14)。para-EV患者再出血风险显著升高(两项队列研究合并分析:RR=13.00,95%CI:2.43-69.56,P=0.003)。本次meta分析中各研究间存在显著异质性。结论:ECV常出现于食管静脉曲张患者,ECV的出现有助于对内镜治疗后食管静脉曲张复发或再出血进行预测。

Background:Endoscopic treatment is recommended for the management of esophageal varices.However,variceal recurrence or rebleeding is common after endoscopic variceal eradication.Our study aimed to systematically evaluate the prevalence of esophageal collateral veins(ECVs)and the association of ECVs with recurrence of esophageal varices or rebleeding from esophageal varices after endoscopic treatment.Methods:We searched the relevant literature through the PubMed,EMBASE,and Cochrane Library databases.Prevalence of paraesophageal veins(para-EVs),periesophageal veins(peri-EVs),and perforating veins(PVs)were pooled.Risk ratio(RR)and odds ratio(OR)with 95%confidence intervals(CIs)were calculated for cohort studies and case-control studies,respectively.A random-effects model was employed.Heterogeneity among studies was calculated.Results:Among the 532 retrieved papers,28 were included.The pooled prevalence of para-EVs,peri-EVs,and PVs in patients with esophageal varices was 73%,88%,and 54%,respectively.The pooled prevalence of para-EVs and PVs in patients with recurrence of esophageal varices was 87%and 62%,respectively.The risk for recurrence of esophageal varices was significantly increased in patients with PVs(OR=9.79,95%CI:1.95-49.22,P=0.006 for eight case-control studies),but not in those with para-EVs(OR=4.26,95%CI:0.38-38.35,P=0.24 for four case-control studies;RR=1.81,95%CI:0.83-3.97,P=0.14 for three cohort studies).Patients with para-EVs had a significantly higher incidence of rebleeding from esophageal varices(RR=13.00,95%CI:2.43-69.56,P=0.003 for two cohort studies).Statistically significant heterogeneity was notable across the meta-analyses.Conclusions:ECVs are common in patients with esophageal varices.Identification of ECVs could be helpful for predicting the recurrence of esophageal varices or rebleeding from esophageal varices after endoscopic treatment.