结肠镜检查时机对急性下消化道出血患者预后影响的Meta分析

Effect of colonoscopy timing on clinical outcomes of patients with acute lower gastrointestinal bleeding:a Meta-analysis

目的系统评价结肠镜检查时机对急性下消化道出血(LGIB)患者预后的影响。方法计算机检索PubMed、Medline、Embase、The Cochrane Library、维普、中国知网和万方数据自建库到2022年9月,结肠镜检查时机对急性LGIB患者预后影响的相关临床研究。由两名研究者独立筛选文献,提取信息,并进行偏倚风险评价后,采用RevMan 5.4软件对急诊结肠镜组和常规结肠镜组的再出血率、内镜下止血成功率、出血来源定位率和总体死亡率等多方面进行Meta分析。结果共纳入12篇回顾性研究和4篇随机对照试验(RCT),包括400180例患者。回顾性研究的Meta分析结果显示,急诊结肠镜在以下4个方面优于常规结肠镜:内镜下止血成功率(OR^=1.64,95%CI:1.07~2.52,P=0.020)、住院天数(MD=-1.67,95%CI:-2.92~-0.42,P=0.009)、外科手术率(OR=0.52,95%CI:0.42~0.64,P=0.000)和输血率(OR=0.83,95%CI:0.78~0.88,P=0.000);两组患者再出血率、总体死亡率、介入治疗率和出血来源定位率比较,差异均无统计学意义(P>0.05)。RCT的Meta分析结果显示,急诊结肠镜内镜下止血成功率(OR=1.74,95%CI:1.04~2.93,P=0.040)和出血来源定位率(OR=2.31,95%CI:1.28~4.17,P=0.006)明显高于常规结肠镜,两组间其他结局指标比较,差异均无统计学意义(P>0.05)。结论与常规结肠镜相比,急诊结肠镜并不能降低再出血率和总体死亡率,但能够提高内镜下止血成功率,并在一定程度上缩短了住院天数,降低了外科手术率和输血率,在临床中需根据实际情况进行时机选择。

Objective To systematically review the effect of colonoscopy timing on the outcomes of patients with acute lower gastrointestinal bleeding(LGIB).Methods PubMed,Medline,Embase,The Cochrane Library,VIP,CNKI and WanFang Data were electronically searched to collect studies on the effect of colonoscopy timing on the outcomes of patients with acute LGIB from inception to September,2022.Two reviewers independently screened the literature,extracted data,and evaluated the risk of bias of the included studies.Subsequently,Meta-analysis was performed using RevMan 5.4 software on rebleeding rate,endoscopic hemostasis rate,bleeding source localization rate,overall mortality rate,etc.Results 12 retrospective studies and 4 randomized controlled trials(RCT)involving 400180 patients were included.The results of retrospective studies showed that compared with elective colonoscopy,urgent colonoscopy was superior in the following aspects:endoscopic hemostasis rate(OR=1.64,95%CI:1.07~2.52,P=0.020),length of stay(MD=-1.67,95%CI:-2.92~-0.42,P=0.009),surgery rate(O R^=0.52,95%CI:0.42~0.64,P=0.000),transfusion rate(OR=0.83,95%CI:0.78~0.88,P=0.000).While no significant differences were observed in rebleeding rate,overall mortality rate,embolization rate and bleeding source localization rate between the two groups.The results of RCT showed that urgent colonoscopy was superior to elective group only on endoscopic hemostasis rate(OR=1.74,95%CI:1.04~2.93,P=0.040)and bleeding source localization rate(OR=2.31,95%CI:1.28~4.17,P=0.006),there was no statistically significant difference in other outcome indicators between the two groups(P>0.05).Conclusion Compared with elective colonoscopy,urgent colonoscopy can’treduce the rate of rebleeding and overall mortality,but may improve the success rate of endoscopic hemostasis and meanwhile reduce the length of stay,rate of surgery and transfusion.Clinicians should make decisions according to the actual situation.