针对结直肠息肉切除术后出血的各种内镜预防措施：随机对照研究的网状Meta分析

Various Endoscopic Prophylaxes for Post-Polypectomy Bleeding in Colorectal Polyps: A Network Meta-Analysis of Randomized Controlled Studies

摘要: 背景：现有关于预防结直肠息肉切除术后出血的研究存在局限性。目的：通过网状meta分析评估各种内镜措施预防结直肠息肉切除术后出血的效果。方法：我们在数据库中检索了有关结直肠息肉切除术后出血的内镜预防的随机对照试验(randomized controlled studies trials, RCTs)，干预措施包括无预防、肾上腺素注射、器械套扎、金属夹封闭、血管热凝、不含器械联合法和含器械联合法。主要结局事件是息肉切除术后的出血。整个分析在频率学框架下进行。结果：共确定了24项研究(10,658名患者，18,454枚结直肠息肉)。肾上腺素注射、器械套扎和含器械联合法的术中出血(intraprocedural bleeding, IPB)和早期出血(early bleeding, EB)率比无预防低。含器械联合法和金属夹封闭的术后出血(postoperative bleeding, PPB)率比无预防低。所有内镜措施的晚期出血(late bleeding, LB)率与无预防相似。结论：对于结直肠息肉，肾上腺素注射，器械套扎和金属夹封闭可根据可行性被选择用于预防术后24小时内的出血。对10 mm以上的结直肠息肉，器械套扎和金属夹封闭可能更有效。尚未发现内镜预防术后24小时至30天内出血的必要性。

Abstract: Background: Existing researches on prevention of post-polypectomy bleeding have limitations. Objective: To assess the effectiveness of various endoscopic prophylaxes preventing post-polypectomy bleeding in network meta-analysis (NMA) based on controlled trials (RCTs). Methods: We searched databases for RCTs on prevention of post-polypectomy bleeding with endoscopic prophylaxis involving no prophylaxis, adrenaline, device ligation, clips closure, electrocoagulation, combined methods without device and combined methods with device. The primary outcome was bleeding events after polypectomy. NMA was conducted within a frequentist framework. Results: A total of 24 RCTs (10,658 patients with 18,454 colorectal polyps) were identified. Adrenaline injection, device ligation, and combined device-containing methods had lower rates of intraprocedural bleeding (IPB) and early bleeding (EB) than no prophylaxis. Combined methods with device and clips closure had lower rates of postoperative bleeding (PPB) no prophylaxis. All endoscopic measures had similar rates of late bleeding (LB) to no prophylaxis. Conclusion: For colorectal polyps, adrenaline injections, device ligation and clips closure may be selected based on feasibility to prevent bleeding within 24 hours from the procedure. For colorectal polyps ≥ 10 mm, device ligation and clips closure may be more effective. The need for endoscopic measures to prevent bleeding 24 hours to 30 days after the procedure has not been identified.