Does Prophylactic Closure Improve Outcomes After Colorectal Endoscopic Submucosal Dissection? A Systematic Review and Meta-analysis.

IF 1.1 4区医学 Q3 SURGERY

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques Pub Date : 2024-02-01 DOI:10.1097/SLE.0000000000001248

Liang Dong, Weihua Zhu, Xiaolei Zhang, Xiao Xie

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引用次数: 0

Abstract

Background: Several studies have described prophylactic closure after endoscopic submucosal dissection (ESD) of colorectal lesions for improving postoperative outcomes. We reviewed the evidence on the impact of prophylactic closure after ESD.

Methods: A literature search was conducted on PubMed, Embase, CENTRAL, and Web of Science by 2 reviewers independently for studies published up to July 9, 2023. All types of comparative studies were eligible.

Results: Ten studies compared 939 patients undergoing prophylactic closure with 1074 controls. Three were randomized controlled trials (RCTs) while the rest were observational. Pooled data from all included studies showed that prophylactic closure resulted in reduced incidence of delayed bleeding after ESD [odds ratio (OR): 0.30; 95% CI: 0.15, 0.72; I2 =0%]. These results were significant only for observational studies but not for RCTs. Meta-analysis showed no significant difference in the risk of delayed perforation (OR: 0.55; 95% CI: 0.18, 1.70; I2 =0%) or post-ESD coagulation syndrome (PECS) (OR: 1.15; 95% CI: 0.41, 3.19; I2 =63%) between closure and nonclosure groups.

Conclusions: Observational data suggest that prophylactic closure of colorectal mucosal defects after ESD may reduce the risk of delayed bleeding. However, the results are not concurred by RCTs. Furthermore, there seems to be no impact of prophylactic closure on the risk of delayed perforation and PECS.

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预防性关闭结肠内镜下粘膜下夹层改善预后吗?系统回顾和荟萃分析。

背景:一些研究描述了内镜下粘膜下剥离(ESD)对结肠直肠病变进行预防性关闭以改善术后预后。我们回顾了ESD后预防性关闭影响的证据。方法:由2位独立审稿人在PubMed、Embase、CENTRAL和Web of Science上检索截至2023年7月9日发表的研究。所有类型的比较研究都是合格的。结果:10项研究比较了939例接受预防性结扎的患者和1074例对照组。其中3项为随机对照试验(rct)，其余为观察性试验。所有纳入研究的汇总数据显示，预防性闭合可降低ESD后迟发性出血的发生率[优势比(OR): 0.30;95% ci: 0.15, 0.72;I2 = 0%)。这些结果仅对观察性研究有意义，而对随机对照试验没有意义。荟萃分析显示，延迟穿孔的风险无显著差异(OR: 0.55;95% ci: 0.18, 1.70;I2=0%)或esd后凝血综合征(PECS) (or: 1.15;95% ci: 0.41, 3.19;I2=63%)。结论:观察数据提示，ESD术后预防性闭合结直肠粘膜缺损可降低迟发性出血的风险。然而，随机对照试验的结果并不一致。此外，预防性关闭似乎对延迟穿孔和PECS的风险没有影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 医学-外科

CiteScore

2.00

自引率

10.00%

发文量

103

审稿时长

3-8 weeks

期刊介绍： Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.