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首页> 外文期刊>Digestive Diseases and Sciences >Somatostatin analogues in the treatment of recurrent bleeding from gastrointestinal vascular malformations: an overview and systematic review of prospective observational studies.
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Somatostatin analogues in the treatment of recurrent bleeding from gastrointestinal vascular malformations: an overview and systematic review of prospective observational studies.

机译：生长抑素类似物在治疗胃肠道血管畸形复发性出血中的作用：前瞻性观察研究的概述和系统综述。

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BACKGROUND: Vascular malformation of the gastrointestinal tract is an uncommon cause for gastrointestinal bleeding. Traditionally, gastroenterologists prefer to use endoscopic modalities like argon plasma coagulation and electrocoagulation to treat accessible lesions. The role of somatostatin analogues (octreotide) in preventing recurrent bleeding in these patients is unclear. The use of pharmacological treatments would be useful especially in refractory bleeding, inaccessible lesions and in patients who are at high risk for invasive interventions. AIMS: To systematically review pooled clinical response rates from prospective studies using somatostatin analogues for prevention of recurrent bleeding from gastrointestinal angiodysplasia and quantify the effects that therapy has on the use of blood transfusions. METHODS: We searched several electronic databases including Pubmed for full journal articles published after 1966 reporting on the use of somatostatin analogues in the treatment of gastrointestinal angiodyplasia. We hand searched the reference lists of all retrieved articles. Prospective studies involving ten or more patients were included in the analysis. We calculated the pooled proportion of patients who had a clinical response to therapy in the selected studies and the weighted mean difference in transfusion requirements before and after therapy. Heterogeneity between the studies was assessed using the I2 statistic. RESULTS: A total of three studies involving 62 patients met the inclusion criteria. The proportional meta-analysis showed a clinical response to treatment of 0.76 (95% CI 0.64-0.85). The weighted mean difference in transfusion requirements before starting therapy (control group) and after treatment initiation (treatment group) was -2.2 (95% CI -3.9 to -0.5). No significant heterogeneity was seen between the studies. CONCLUSIONS: A significant number of patients with bleeding gastrointestinal angiodysplasia respond to treatment with octreotide by reducing the need for blood products. As all the included studies had small sample sizes, multicenter randomized trials are needed to confirm these findings. However, it seems reasonable to administer octreotide especially in patients with refractory bleeding, inaccessible lesions and in patients at high risk for other interventions.
机译：背景：胃肠道血管畸形是胃肠道出血的常见原因。传统上，肠胃科医生更喜欢使用内窥镜检查方法，如氩气血浆凝结和电凝治疗可触及的病变。生长抑素类似物（奥曲肽）在预防这些患者复发性出血中的作用尚不清楚。特别是在难治性出血，难以触及的病变以及侵入性干预风险高的患者中，药物治疗将很有用。目的：系统回顾使用生长抑素类似物预防胃肠道血管增生引起的复发性出血的前瞻性研究汇总的临床反应率，并量化治疗对输血的影响。方法：我们搜索了包括Pubmed在内的几个电子数据库，以获得1966年后发表的有关生长抑素类似物在胃肠道血管增生治疗中的使用的完整期刊文章。我们手工搜索了所有检索到的文章的参考列表。分析涉及10名或10名以上患者的前瞻性研究。我们计算了所选研究中对治疗产生临床反应的患者的总比例，以及治疗前后输血需求的加权平均差异。使用I2统计量评估研究之间的异质性。结果：总共三项涉及62例患者的研究符合纳入标准。比例荟萃分析显示治疗的临床反应为0.76（95％CI 0.64-0.85）。开始治疗前（对照组）和开始治疗后（治疗组）的输血需求加权平均差为-2.2（95％CI -3.9至-0.5）。研究之间没有发现明显的异质性。结论：大量胃肠道血管增生异常出血的患者通过减少对血液制品的需求对奥曲肽治疗有反应。由于所有纳入的研究均样本量较小，因此需要多中心随机试验来证实这些发现。但是，服用奥曲肽似乎是合理的，尤其是在难治性出血，难以接近的病变以及其他干预措施高风险的患者中。

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