| Background and objective:Dieulafoy’s disease is a kind of abnormal arterial disease,which is the rupture and bleeding of submucosal constant diameter small arteries.It mainly manifests as sudden occurrence of large amounts of hematemesis or bloody stools without obvious causes.The bleeding is periodic and prone to recurrence.The incidence of hemorrhagic shock is high.About 80%of patients are found under endoscopy,and endoscopic treatment is the first line of treatment.The first successful endoscopic hemostasis can reach over 80%,and most patients with recurrent bleeding can receive endoscopic hemostasis treatment again,with a small number requiring surgery.There is no authoritative recommendation regarding the hemostatic methods for Dieulafoy’s disease,and the clinical use is mostly determined based on endoscopy and clinical manifestations.There is currently limited research on Dieulafoy’s disease and there are differences in results.This study uses a network meta-analysis to comprehensively evaluate the efficacy differences of various endoscopic treatment measures,and seeks excellent endoscopic hemostatic treatment for Dieulafoy’s disease bleeding.Methods:Using Dieulafoy’s disease and other search terms,we searched 8 Chinese and English databases,including CNKI and PubMed,for all relevant literature from the establishment of the database to March 20,2023.According to the inclusion and exclusion criteria,two professional evaluators will gradually select studies that meet the criteria based on the literature title,abstract,and full text.Extract relevant data for inclusion in the study and conduct bias risk assessment.Using RR or RD as the effector,αTake 0.05 as the inspection level.Perform network meta-analysis on three groups:cure rate,early hemostasis rate,and rebleeding rate.Firstly,similarity,homogeneity,and consistency were tested for inclusion in the study.When I~2is greater than 50%,it indicates substantial heterogeneity,and meta regression or subgroup analysis is needed to identify the source of heterogeneity.When I~2is less than 50%,indicating good homogeneity,inconsistency testing is performed through global inconsistency testing,node splitting inconsistency testing,and loop inconsistency testing.If P is greater than 0.05,indicating good consistency,a consistency model can be used;otherwise,an inconsistency model can be used for analysis.Finally,analyze and interpret the results of network meta-analysis such as mesh maps,forest maps,SUCRA maps,and league maps to find excellent endoscopic hemostasis methods.Results:14 randomized controlled studies were included,involving 11 endoscopic hemostasis methods,including 733 patients with Dieulafoy’s disease.There are 14studies included in the comparison of cure rates,and their similarity,homogeneity,and heterogeneity are all good.According to the results of the network meta-analysis,The order of cure rate is OTSC>traditional endoscopic clip combined with sclerotherapy injection>tissue glue injection>traditional endoscopic clip combined with argon ion beam coagulation>traditional endoscopic clip combined with adrenaline injection>endoscopic ligation>traditional endoscopic clip>argon ion beam coagulation>high-frequency electrocoagulation>sclerotherapy injection>adrenaline injection.Most of the two comparisons have statistical significance,and the funnel plot is more symmetrical with less publication bias.The studies that included early hemostasis rate and rebleeding rate were the same seven studies,with good homogeneity and consistency.The results of the mesh meta-analysis showed that in terms of early hemostasis rate,traditional endoscopic clips combined with argon ion beam coagulation>endoscopic ligation>traditional endoscopic clips>argon ion beam coagulation>sclerotherapy injection>high-frequency electrocoagulation,In terms of rebleeding rate:sclerotherapy injection>argon ion beam coagulation>high-frequency electrocoagulation>traditional endoscopic clamp>endoscopic ligation>traditional endoscopic clamp combined with argon ion beam coagulation,there was no statistically significant difference between the two groups,and the publication bias was relatively small.Conclusion:Comprehensive analysis shows that for patients with Dieulafoy’s disease bleeding,OTSC is worth using,followed by tissue glue injection therapy or traditional endoscopic clips combined with other treatment methods.The use of adrenaline injection alone,sclerotherapy injection,high-frequency electrocoagulation,and argon ion beam coagulation for hemostasis treatment should be carefully considered.Endoscopic ligation and traditional endoscopic clips are selected based on clinical conditions.There are currently few clinical studies on the treatment of Dieulafoy’s disease,and more randomized controlled studies are needed to evaluate the advantages and disadvantages of various treatment measures and provide better recommendations for clinical decision-making. |
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