Efficacy and safety of stem cell therapy for fistula management: An overview of existing systematic reviews.

IF 12.5 2区 医学 Q1 SURGERY
Tripti Tripathi, Syam Mohan, Hassan Ahmad Alfaifi, Abdullah Farasani, Roopashree R, Pawan Sharma, Abhishek Sharma, Apurva Koul, G V Siva Prasad, Sarvesh Rustagi, Jigisha Anand, Sanjit Sah, Shilpa Gaidhane, Ganesh Bushi, Diptismita Jena, Mahalaqua Nazli Khatib, Muhammed Shabil, Siddig Ibrahim Abdelwahab, Kiran Bhopte, Manvi Pant, Rachana Mehta, Sakshi Pandey, Manvinder Brar, Nagavalli Chilakam, Ashok Kumar Balaraman
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引用次数: 0

Abstract

Background: Fistulas, abnormal connections between two anatomical structures, significantly impact the quality of life and can result from a variety of causes, including congenital defects, inflammatory conditions, and surgical complications. Stem cell therapy has emerged as a promising alternative due to its potential for regenerative and immunomodulatory effects. This overview of systematic reviews aimed to assess the safety and efficacy of stem cell therapy in managing fistulas, drawing on the evidence available.

Methods: This umbrella review was conducted following the Joanna Briggs Institute (JBI) methodology to assess the efficacy and safety of stem cell therapy for treating various types of fistulas. A comprehensive search was performed across multiple electronic databases including PubMed, Embase, Cochrane Register, and Web of Science up to May 5th, 2024. Systematic reviews focusing on stem cell therapy for fistulas were included, with data extracted on study design, stem cell types, administration methods, and outcomes. The quality of the reviews was assessed using the AMSTAR 2 tool, and meta-analyses were conducted using R software version 4.3.

Results: Nineteen systematic reviews were included in our umbrella review. The stem cell therapy demonstrated by significant improvements in clinical remission rates, with a relative risk (RR) of 1.299 (95% CI: 1.192 to 1.420). Stem cell therapy enhanced fistula closure rates, both short-term (RR=1.481; 95% CI: 1.036 to 2.116) and long-term (RR=1.422; 95% CI: 1.091 to 1.854). The safety analysis revealed no significant increase in the risk of adverse events with stem cell therapy, showing a pooled RR of 0.972 (95% CI: 0.739 to 1.278) for general adverse events and 1.136 (95% CI: 0.821 to 1.572) for serious adverse events, both of which indicate a safety profile comparable to control treatments. Re-epithelialization rates also improved (RR=1.44; 95% CI: 1.322 to 1.572).

Conclusion: Stem cell therapy shows promise as an effective and safe treatment for fistulas, particularly in inducing remission and promoting closure of complex fistulas. The findings advocate for further high-quality research to confirm these benefits and potentially incorporate stem cell therapy into standard clinical practice for fistula management. Future studies should focus on long-term outcomes and refining stem cell treatment protocols to optimize therapeutic efficacy.

干细胞疗法治疗瘘管的有效性和安全性:现有系统回顾综述。
背景:瘘管是两个解剖结构之间的异常连接,严重影响生活质量,可由多种原因导致,包括先天性缺陷、炎症和手术并发症。干细胞疗法因其潜在的再生和免疫调节作用,已成为一种前景广阔的替代疗法。本系统综述旨在根据现有证据,评估干细胞疗法治疗瘘管的安全性和有效性:本综述采用乔安娜-布里格斯研究所(Joanna Briggs Institute,JBI)的方法,评估干细胞疗法治疗各种类型瘘管的有效性和安全性。截至2024年5月5日,我们对多个电子数据库进行了全面检索,包括PubMed、Embase、Cochrane Register和Web of Science。研究包括干细胞治疗瘘管的系统性综述,并提取有关研究设计、干细胞类型、施用方法和结果的数据。使用AMSTAR 2工具对综述质量进行评估,并使用R软件4.3版进行荟萃分析:19篇系统综述被纳入我们的总综述。干细胞疗法显著提高了临床缓解率,相对风险(RR)为1.299(95% CI:1.192至1.420)。干细胞疗法提高了瘘管闭合率,无论是短期(RR=1.481;95% CI:1.036 至 2.116)还是长期(RR=1.422;95% CI:1.091 至 1.854)。安全性分析显示,干细胞疗法的不良事件风险没有明显增加,一般不良事件的综合RR为0.972(95% CI:0.739至1.278),严重不良事件的综合RR为1.136(95% CI:0.821至1.572),两者均表明干细胞疗法的安全性与对照疗法相当。再上皮化率也有所提高(RR=1.44;95% CI:1.322 至 1.572):干细胞疗法有望成为一种有效、安全的瘘管治疗方法,尤其是在诱导缓解和促进复杂瘘管闭合方面。研究结果主张进一步开展高质量研究,以确认这些益处,并有可能将干细胞疗法纳入瘘管治疗的标准临床实践中。未来的研究应关注长期疗效,并完善干细胞治疗方案,以优化疗效。
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
CiteScore
17.70
自引率
3.30%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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