Splenectomy non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis
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 a...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2024-03-01
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| Series: | Therapeutic Advances in Gastroenterology |
| Online Access: | https://doi.org/10.1177/17562848241234501 |
| _version_ | 1797274721999388672 |
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| author | Minghui Liu Ning Wei Yuhu Song |
| author_facet | Minghui Liu Ning Wei Yuhu Song |
| author_sort | Minghui Liu |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-07T15:02:20Z |
| format | Article |
| id | doaj.art-6a7d546d51cb48db8abc29af82dfcc2b |
| institution | Directory Open Access Journal |
| issn | 1756-2848 |
| language | English |
| last_indexed | 2024-03-07T15:02:20Z |
| publishDate | 2024-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Gastroenterology |
| spelling | doaj.art-6a7d546d51cb48db8abc29af82dfcc2b2024-03-05T19:03:35ZengSAGE PublishingTherapeutic Advances in Gastroenterology1756-28482024-03-011710.1177/17562848241234501Splenectomy non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysisMinghui LiuNing WeiYuhu SongObjectives: 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.https://doi.org/10.1177/17562848241234501 |
| spellingShingle | Minghui Liu Ning Wei Yuhu Song Splenectomy non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis Therapeutic Advances in Gastroenterology |
| title | Splenectomy non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis |
| title_full | Splenectomy non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis |
| title_fullStr | Splenectomy non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis |
| title_full_unstemmed | Splenectomy non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis |
| title_short | Splenectomy non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis |
| title_sort | splenectomy non splenectomy for gastrointestinal bleeding from left sided portal hypertension a systematic review and meta analysis |
| url | https://doi.org/10.1177/17562848241234501 |
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