Splenectomy versus non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis.

IF 3.9 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Therapeutic Advances in Gastroenterology Pub Date : 2024-03-04 eCollection Date: 2024-01-01 DOI:10.1177/17562848241234501

Minghui Liu, Ning Wei, Yuhu Song

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Abstract

Objectives: Left-sided portal hypertension (LSPH) leads to life-threatening gastrointestinal (GI) bleeding. There are no recommendations or consensus about the management of GI bleeding caused by LSPH. This systematic review and meta-analysis were conducted to evaluate the incidence of GI bleeding and the mortality of patients with LSPH receiving different therapeutic strategies.

Design: A systematic review and meta-analysis were performed to determine the efficacy of different therapeutic strategies for GI bleeding caused by LSPH.

Data sources and methods: All relevant studies were searched from PubMed, Embase, Web of Science, Cochrane Library, Scopus, ScienceDirect, MEDLINE, Google Scholar, CNKI, and Wanfang Data without language restriction through 15 November 2023. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated through RevMan5.3 software. (The Cochrane Collaboration, Copenhagen, Denmark).

Results: Seventeen retrospective studies and one prospective study involving 624 patients were included. This systematic review and meta-analysis found that: (1) splenectomy was more effective than non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding caused by LSPH (OR: 0.12; 95% CI: 0.06-0.27); (2) splenectomy was superior to partial splenic artery embolism (PSAE) (OR: 0.06; 95% CI: 0.01-0.62) or endoscopic interventions (OR: 0.04; 95% CI: 0.01-0.19) in the prevention of GI bleeding, respectively; (3) no significant difference in the mortality was observed between splenectomy and non-splenectomy therapeutic strategies (OR: 0.46; 95% CI: 0.20-1.08); and (4) patients receiving preoperative PSAE followed by splenectomy had less intraoperative bleeding and shorter operative time than those receiving splenectomy.

Conclusion: This meta-analysis demonstrated that splenectomy is superior to non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding from LSPH, which revealed that splenectomy should be recommended in the management of these patients.

Trial registration: This study has been registered on the PROSPERO database with the registration number CRD42023483764.

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脾切除术与非脾切除术治疗左侧门静脉高压引起的消化道出血：系统综述和荟萃分析。

目的：左侧门静脉高压症（LSPH）会导致危及生命的消化道（GI）出血。对于 LSPH 引起的消化道出血的治疗，目前尚无建议或共识。本系统综述和荟萃分析旨在评估接受不同治疗策略的 LSPH 患者消化道出血的发生率和死亡率：通过系统综述和荟萃分析，确定不同治疗策略对 LSPH 引起的消化道出血的疗效：截至2023年11月15日，在PubMed、Embase、Web of Science、Cochrane Library、Scopus、ScienceDirect、MEDLINE、Google Scholar、CNKI和万方数据中检索了所有相关研究，无语言限制。比值比（OR）和 95% 置信区间（CI）通过 RevMan5.3 软件计算。(结果：结果：共纳入 17 项回顾性研究和 1 项前瞻性研究，涉及 624 名患者。这项系统回顾和荟萃分析发现(1）在降低 LSPH 引起的消化道出血发生率方面，脾切除术比非脾切除术治疗策略更有效（OR：0.12；95% CI：0.06-0.27）；（2）在预防消化道出血方面，脾切除术优于部分脾动脉栓塞（PSAE）（OR：0.06；95% CI：0.01-0.62）或内镜干预（OR：0.04；95% CI：0.01-0.19）。19）分别预防消化道出血；（3）脾切除与非脾切除治疗策略在死亡率方面无显著差异（OR：0.46；95% CI：0.20-1.08）；（4）与接受脾切除术的患者相比，术前接受PSAE后再接受脾切除术的患者术中出血更少，手术时间更短：这项荟萃分析表明，在降低 LSPH 消化道出血发生率方面，脾切除术优于非脾切除术治疗策略，这表明在治疗这些患者时应推荐脾切除术：本研究已在 PROSPERO 数据库注册，注册号为 CRD42023483764。

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来源期刊

Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.70

自引率

2.40%

发文量

103

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.