Paulo Salgueiro, Maria Inês Ramos, Fernando Castro-Poças, Diogo Libânio
{"title":"痔疮疾病管理的办公室程序:橡皮筋结扎与硬化疗法-系统评价和荟萃分析。","authors":"Paulo Salgueiro, Maria Inês Ramos, Fernando Castro-Poças, Diogo Libânio","doi":"10.1159/000522171","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The most frequently used office-based procedures in hemorrhoidal disease (HD) are rubber band ligation (RBL) and sclerotherapy. Few studies have been published comparing the various types of instrumental therapy. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of sclerotherapy and RBL.</p><p><strong>Methods: </strong>Three online databases were searched. Efficacy (control of symptoms, prolapse, bleeding and pain, patients' satisfaction, and disease recurrence) and safety (complications, such as pain and bleeding) were the assessed outcomes. Pooled relative risks (RR) were computed for each outcome using a random-effects model, and heterogeneity was assessed by Cochran's Q test and <i>I</i><sup>2</sup>.</p><p><strong>Results: </strong>Six RCTs and three cohort studies were included. Control of prolapse and bleeding was significantly higher with RBL (93.1% RBL vs. 66.4% sclerotherapy, RR 1.34, 95% CI 1.12-1.60 and 89.1% RBL vs. 78.7% SCL, RR 1.17, 95% CI 1.02-1.34, respectively). Both techniques had similar results in terms of pain relief, overall control of symptoms, and risk of recurrence at 3 months. Although patient satisfaction was significantly higher with RBL (77.8% RBL vs. 46.7% sclerotherapy, RR 1.59, 95% CI 1.01-2.50), post-procedural pain was significantly higher with this technique (24% RBL vs. 14% sclerotherapy, RR 1.74, 95% CI 1.32-2.28). There was no significant difference regarding post-procedure bleeding (11.1% RBL vs. 8.7% sclerotherapy, RR 1.29, 95% CI 0.86-1.94). In the subgroup analysis, according to the HD grade, post-procedure pain was higher with RBL only in HD grade II (vs. HD grade I-III).</p><p><strong>Conclusions: </strong>RBL performs better than sclerotherapy in controlling HD symptoms, specifically prolapse and bleeding, although post-procedural pain is a frequent complication. Recurrence is similar with both procedures. While waiting for the publication of results with sclerotherapy with new sclerosants, RBL remains the office-based treatment of choice in HD.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"29 6","pages":"409-419"},"PeriodicalIF":1.0000,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a8/eb/pjg-0029-0409.PMC9761374.pdf","citationCount":"1","resultStr":"{\"title\":\"Office-Based Procedures in the Management of Hemorrhoidal Disease: Rubber Band Ligation versus Sclerotherapy - Systematic Review and Meta-Analysis.\",\"authors\":\"Paulo Salgueiro, Maria Inês Ramos, Fernando Castro-Poças, Diogo Libânio\",\"doi\":\"10.1159/000522171\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The most frequently used office-based procedures in hemorrhoidal disease (HD) are rubber band ligation (RBL) and sclerotherapy. Few studies have been published comparing the various types of instrumental therapy. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of sclerotherapy and RBL.</p><p><strong>Methods: </strong>Three online databases were searched. Efficacy (control of symptoms, prolapse, bleeding and pain, patients' satisfaction, and disease recurrence) and safety (complications, such as pain and bleeding) were the assessed outcomes. Pooled relative risks (RR) were computed for each outcome using a random-effects model, and heterogeneity was assessed by Cochran's Q test and <i>I</i><sup>2</sup>.</p><p><strong>Results: </strong>Six RCTs and three cohort studies were included. Control of prolapse and bleeding was significantly higher with RBL (93.1% RBL vs. 66.4% sclerotherapy, RR 1.34, 95% CI 1.12-1.60 and 89.1% RBL vs. 78.7% SCL, RR 1.17, 95% CI 1.02-1.34, respectively). Both techniques had similar results in terms of pain relief, overall control of symptoms, and risk of recurrence at 3 months. Although patient satisfaction was significantly higher with RBL (77.8% RBL vs. 46.7% sclerotherapy, RR 1.59, 95% CI 1.01-2.50), post-procedural pain was significantly higher with this technique (24% RBL vs. 14% sclerotherapy, RR 1.74, 95% CI 1.32-2.28). There was no significant difference regarding post-procedure bleeding (11.1% RBL vs. 8.7% sclerotherapy, RR 1.29, 95% CI 0.86-1.94). In the subgroup analysis, according to the HD grade, post-procedure pain was higher with RBL only in HD grade II (vs. HD grade I-III).</p><p><strong>Conclusions: </strong>RBL performs better than sclerotherapy in controlling HD symptoms, specifically prolapse and bleeding, although post-procedural pain is a frequent complication. Recurrence is similar with both procedures. While waiting for the publication of results with sclerotherapy with new sclerosants, RBL remains the office-based treatment of choice in HD.</p>\",\"PeriodicalId\":51838,\"journal\":{\"name\":\"GE Portuguese Journal of Gastroenterology\",\"volume\":\"29 6\",\"pages\":\"409-419\"},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2022-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a8/eb/pjg-0029-0409.PMC9761374.pdf\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"GE Portuguese Journal of Gastroenterology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1159/000522171\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"GE Portuguese Journal of Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000522171","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 1
摘要
简介:痔疮病(HD)最常用的办公室手术是橡皮筋结扎(RBL)和硬化疗法。很少有研究发表比较不同类型的器械治疗。本系统综述和荟萃分析的目的是比较硬化疗法和RBL的疗效和安全性。方法:检索3个在线数据库。疗效(症状、脱垂、出血和疼痛的控制、患者满意度和疾病复发)和安全性(并发症，如疼痛和出血)是评估的结果。使用随机效应模型计算每个结果的合并相对风险(RR)，并通过Cochran’s Q检验和I2评估异质性。结果:纳入6项随机对照试验和3项队列研究。RBL组脱垂和出血的控制率显著高于硬化治疗组(93.1% RBL vs 66.4%， RR 1.34, 95% CI 1.12-1.60; 89.1% RBL vs 78.7% SCL, RR 1.17, 95% CI 1.02-1.34)。两种方法在疼痛缓解、症状总体控制和3个月复发风险方面的结果相似。尽管RBL治疗的患者满意度明显更高(77.8% RBL vs 46.7%硬化治疗，RR 1.59, 95% CI 1.01-2.50)，但术后疼痛明显更高(24% RBL vs 14%硬化治疗，RR 1.74, 95% CI 1.32-2.28)。术后出血方面无显著差异(RBL组为11.1%，硬化治疗组为8.7%，RR 1.29, 95% CI 0.86-1.94)。在亚组分析中，根据HD级别，RBL仅在HD II级患者的术后疼痛更高(与HD I-III级患者相比)。结论:RBL在控制HD症状方面优于硬化疗法，特别是脱垂和出血，尽管术后疼痛是常见的并发症。两种手术的复发率相似。在等待用新的硬化剂进行硬化治疗的结果发表的同时，RBL仍然是HD的主要治疗选择。
Office-Based Procedures in the Management of Hemorrhoidal Disease: Rubber Band Ligation versus Sclerotherapy - Systematic Review and Meta-Analysis.
Introduction: The most frequently used office-based procedures in hemorrhoidal disease (HD) are rubber band ligation (RBL) and sclerotherapy. Few studies have been published comparing the various types of instrumental therapy. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of sclerotherapy and RBL.
Methods: Three online databases were searched. Efficacy (control of symptoms, prolapse, bleeding and pain, patients' satisfaction, and disease recurrence) and safety (complications, such as pain and bleeding) were the assessed outcomes. Pooled relative risks (RR) were computed for each outcome using a random-effects model, and heterogeneity was assessed by Cochran's Q test and I2.
Results: Six RCTs and three cohort studies were included. Control of prolapse and bleeding was significantly higher with RBL (93.1% RBL vs. 66.4% sclerotherapy, RR 1.34, 95% CI 1.12-1.60 and 89.1% RBL vs. 78.7% SCL, RR 1.17, 95% CI 1.02-1.34, respectively). Both techniques had similar results in terms of pain relief, overall control of symptoms, and risk of recurrence at 3 months. Although patient satisfaction was significantly higher with RBL (77.8% RBL vs. 46.7% sclerotherapy, RR 1.59, 95% CI 1.01-2.50), post-procedural pain was significantly higher with this technique (24% RBL vs. 14% sclerotherapy, RR 1.74, 95% CI 1.32-2.28). There was no significant difference regarding post-procedure bleeding (11.1% RBL vs. 8.7% sclerotherapy, RR 1.29, 95% CI 0.86-1.94). In the subgroup analysis, according to the HD grade, post-procedure pain was higher with RBL only in HD grade II (vs. HD grade I-III).
Conclusions: RBL performs better than sclerotherapy in controlling HD symptoms, specifically prolapse and bleeding, although post-procedural pain is a frequent complication. Recurrence is similar with both procedures. While waiting for the publication of results with sclerotherapy with new sclerosants, RBL remains the office-based treatment of choice in HD.
期刊介绍：
The ''GE Portuguese Journal of Gastroenterology'' (formerly Jornal Português de Gastrenterologia), founded in 1994, is the official publication of Sociedade Portuguesa de Gastrenterologia (Portuguese Society of Gastroenterology), Sociedade Portuguesa de Endoscopia Digestiva (Portuguese Society of Digestive Endoscopy) and Associação Portuguesa para o Estudo do Fígado (Portuguese Association for the Study of the Liver). The journal publishes clinical and basic research articles on Gastroenterology, Digestive Endoscopy, Hepatology and related topics. Review articles, clinical case studies, images, letters to the editor and other articles such as recommendations or papers on gastroenterology clinical practice are also considered. Only articles written in English are accepted.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
