Abstract：
OBJECTIVE: Patients with Barrett\'s esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC.
METHODS: We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett\'s esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM.
RESULTS: Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872-0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005-0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007-0.055; I2=0%).
CONCLUSIONS: Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.
METHODS: We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett\'s esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM.
RESULTS: Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872-0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005-0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007-0.055; I2=0%).
CONCLUSIONS: Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.
摘要：
目的：Barrett食管患者发生食管腺癌的风险增加。内窥镜治疗旨在根除发育不良和化生组织。混合氩等离子体凝固术（混合APC）利用粘膜下液体注射在消融之前创建保护垫，以保护粘膜下层免受损伤。我们进行了汇总荟萃分析，以评估混合APC的安全性和有效性。
方法：我们于2022年4月对主要电子数据库进行了系统搜索。纳入发育异常和非发育异常的Barrett食管患者的研究有资格接受混合APC治疗。结果指标包括完全缓解肠上皮化生（CR-IM），狭窄形成,严重不良事件,以及实现CR-IM所需的会话数量。
结果：接受混合APC的患者的总体合并CR-IM率为90.8%（95%置信区间[CI]，0.872-0.939；I2=0%）。集合狭窄率为2.0％（95％CI，0.005-0.042；I2=0％）。总体严重不良事件发生率为2.7%（95%CI，0.007-0.055；I2=0%）。
结论：当前荟萃分析的结果表明，混合APC与高CR-IM发生率和良好的安全性有关。这些结果的解释受到回顾性队列和病例系列数据的限制。标准化治疗和结果评估方案的随机对照试验是必要的，以了解这种治疗方案与当前的护理标准具有可比性。
方法：我们于2022年4月对主要电子数据库进行了系统搜索。纳入发育异常和非发育异常的Barrett食管患者的研究有资格接受混合APC治疗。结果指标包括完全缓解肠上皮化生（CR-IM），狭窄形成,严重不良事件,以及实现CR-IM所需的会话数量。
结果：接受混合APC的患者的总体合并CR-IM率为90.8%（95%置信区间[CI]，0.872-0.939；I2=0%）。集合狭窄率为2.0％（95％CI，0.005-0.042；I2=0％）。总体严重不良事件发生率为2.7%（95%CI，0.007-0.055；I2=0%）。
结论：当前荟萃分析的结果表明，混合APC与高CR-IM发生率和良好的安全性有关。这些结果的解释受到回顾性队列和病例系列数据的限制。标准化治疗和结果评估方案的随机对照试验是必要的，以了解这种治疗方案与当前的护理标准具有可比性。
