括约肌切开术与用于缓解奥奇氏括约肌功能障碍患者疼痛的假手术：系统回顾和元分析

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-01-01 DOI:10.1016/j.tige.2023.10.003

Dennis Wang, Kayla Dadgar, Mohammad Yaghoobi

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引用次数: 0

摘要

背景和目的内镜下括约肌切开术（ES）曾是奥奇括约肌功能障碍（SOD）治疗的一部分，但最近的研究改变了人们对其效用的看法。我们对研究 ES 治疗胆道 SOD 相关疼痛的随机假对照试验（RCT）进行了系统回顾和荟萃分析。我们纳入了对胆囊切除术后年龄≥18 岁的胆道 SOD 患者进行 ES 与假手术比较的 RCT。我们使用了标准化数据收集表和偏倚风险 2 工具。采用随机效应模型计算风险比 (RR) 和 95% 置信区间 (CI)。亚组包括正常与异常Oddi括约肌测压（SOM）和II型与III型SOD。结果从检索到的517篇文章中，共纳入了4项RCT，涉及376名患者。总体而言，ES 与假手术在改善胆道 SOD 相关疼痛方面没有差异（RR 1.32，95% CI 0.77-2.26，P = .31），正常（RR 0.83，95% CI 0.42-1.65，P = .60）和异常 SOM 亚组（RR 1.90，95% CI 0.84-4.29，P = .12）也没有差异。在 II 型（RR 2.51，95% CI 1.32-4.81，P = .005）而非 III 型 SOD（RR 1.02，95% CI 0.32-3.27，P = .98）患者中，ES 在数字上优于假手术。然而，这些基于类型的亚组之间没有明显的亚组差异（P = .18，I2 = 43.2%）。结论ES不能改善总体胆道SOD相关疼痛，也不能改善II型与III型SOD或正常与异常SOM亚组的疼痛。这项荟萃分析证实，SOM 或 ES 在控制 SOD 方面没有公认的作用。

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Sphincterotomy vs Sham Procedure for Pain Relief in Sphincter of Oddi Dysfunction: Systematic Review and Meta-analysis

Background and Aims

Endoscopic sphincterotomy (ES) used to be part of sphincter of Oddi dysfunction (SOD) management, but recent studies changed attitudes about its utility. We conducted a systematic review and meta-analysis of randomized sham-controlled trials (RCTs) investigating ES for biliary SOD-related pain.

Methods

Articles were retrieved from PubMed, Medline, Embase, and CENTRAL. We included RCTs comparing ES with a sham procedure on post-cholecystectomy patients ≥18 years old with biliary SOD. Standardized data collection sheets were used, as well as the Risk of Bias 2 tool. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Subgroups included normal vs abnormal sphincter of Oddi manometry (SOM) and type II vs III SOD.

Results

From 517 articles retrieved, 4 RCTs were included, encompassing 376 patients. Overall, no difference existed between ES and the sham procedure in improving biliary SOD-related pain overall (RR 1.32, 95% CI 0.77-2.26, P = .31) and for the normal (RR 0.83, 95% CI 0.42-1.65, P = .60) and abnormal SOM subgroups (RR 1.90, 95% CI 0.84-4.29, P = .12). ES was numerically favored over the sham procedure in patients with type II (RR 2.51, 95% CI 1.32-4.81, P = .005) but not type III SOD (RR 1.02, 95% CI 0.32-3.27, P = .98). However, there was no significant subgroup difference between these type-based subgroups (P = .18, I² = 43.2%).

Conclusion

ES does not improve biliary SOD-related pain overall or for type II vs III SOD or normal vs abnormal SOM subgroups. This meta-analysis confirms that there is no proven role for SOM or ES in managing SOD.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.