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Abstract：
Argon plasma coagulation (APC) is an alternate ablative method to radiofrequency ablation for the treatment of Barrett\'s esophagus (BE), and it is preferred due to its lower cost and widespread availability. The present meta-analysis aimed to analyze the safety and efficacy of APC for the management of BE.
A literature search from January 2000 to November 2022 was done for studies analyzing the outcome of APC in BE. The primary outcomes were clearance rate of intestinal metaplasia and adverse events (AE). Pooled event rates were expressed with summative statistics.
A total of 38 studies were included in the final analysis. The pooled event rate for clearance rate of intestinal metaplasia with APC in BE was 86.8% (95% confidence interval [CI], 83.5% to 90.2%), with high-power and hybrid APC having a higher rate compared to standard APC. The pooled incidence of AE with APC in BE was 22.5% (95% CI, 15.3% to 29.7%), without any significant difference between the subgroups, with self-limited chest pain being the commonest AE. The incidence of serious AE was only 0.4% (95% CI, 0.0% to 1.0%), while stricture development was seen only in 1.7% (95% CI, 0.9% to 2.6%) of cases. The pooled recurrence rate of BE was 16.1% (95% CI, 10.7% to 21.6%), with a significantly lower recurrence with high-power APC than standard APC.
High-power and hybrid APC seem to have an advantage over standard APC in terms of clearance rate and recurrence rate. Further studies are required to compare the efficacy and safety of hybrid APC with standard APC and radiofrequency ablation.
A literature search from January 2000 to November 2022 was done for studies analyzing the outcome of APC in BE. The primary outcomes were clearance rate of intestinal metaplasia and adverse events (AE). Pooled event rates were expressed with summative statistics.
A total of 38 studies were included in the final analysis. The pooled event rate for clearance rate of intestinal metaplasia with APC in BE was 86.8% (95% confidence interval [CI], 83.5% to 90.2%), with high-power and hybrid APC having a higher rate compared to standard APC. The pooled incidence of AE with APC in BE was 22.5% (95% CI, 15.3% to 29.7%), without any significant difference between the subgroups, with self-limited chest pain being the commonest AE. The incidence of serious AE was only 0.4% (95% CI, 0.0% to 1.0%), while stricture development was seen only in 1.7% (95% CI, 0.9% to 2.6%) of cases. The pooled recurrence rate of BE was 16.1% (95% CI, 10.7% to 21.6%), with a significantly lower recurrence with high-power APC than standard APC.
High-power and hybrid APC seem to have an advantage over standard APC in terms of clearance rate and recurrence rate. Further studies are required to compare the efficacy and safety of hybrid APC with standard APC and radiofrequency ablation.
摘要：
■氩气凝固术（APC）是射频消融治疗Barrett食管（BE）的替代消融方法，它是首选，因为它的成本较低和广泛的可用性。本荟萃分析旨在分析APC治疗BE的安全性和有效性。
■从2000年1月至2022年11月进行了文献检索，以分析APC在BE中的结果。主要结果是肠上皮化生清除率和不良事件（AE）。汇总事件发生率用总结性统计学表示。
■共有38项研究纳入最终分析。合并事件对BE中APC肠化生清除率的比率为86.8%(95%可信区间[CI],83.5%至90.2%)，与标准APC相比，高功率和混合APC具有更高的速率。BE中APC合并AE的合并发生率为22.5％（95％CI，15.3％至29.7％），亚组之间没有任何显著差异，自限性胸痛是最常见的AE。严重AE的发生率仅为0.4％（95％CI，0.0％至1.0％），而仅在1.7％（95％CI，0.9％至2.6％）的病例中观察到狭窄发展。BE的合并复发率为16.1％（95％CI，10.7％至21.6％），高功率APC的复发率明显低于标准APC。
■高功率和混合APC似乎在清除率和复发率方面比标准APC具有优势。需要进一步的研究来比较混合APC与标准APC和射频消融的疗效和安全性。
■从2000年1月至2022年11月进行了文献检索，以分析APC在BE中的结果。主要结果是肠上皮化生清除率和不良事件（AE）。汇总事件发生率用总结性统计学表示。
■共有38项研究纳入最终分析。合并事件对BE中APC肠化生清除率的比率为86.8%(95%可信区间[CI],83.5%至90.2%)，与标准APC相比，高功率和混合APC具有更高的速率。BE中APC合并AE的合并发生率为22.5％（95％CI，15.3％至29.7％），亚组之间没有任何显著差异，自限性胸痛是最常见的AE。严重AE的发生率仅为0.4％（95％CI，0.0％至1.0％），而仅在1.7％（95％CI，0.9％至2.6％）的病例中观察到狭窄发展。BE的合并复发率为16.1％（95％CI，10.7％至21.6％），高功率APC的复发率明显低于标准APC。
■高功率和混合APC似乎在清除率和复发率方面比标准APC具有优势。需要进一步的研究来比较混合APC与标准APC和射频消融的疗效和安全性。
