PDF(Pubmed)
Abstract：
BACKGROUND: Endoscopic treatment is increasingly used for refractory gastroesophageal reflux disease (rGERD). Unlike the mechanism of conventional surgical fundoplication, gastroesophageal junction ligation, anti-reflux mucosal intervention, and radiofrequency ablation have extremely similar anti-reflux mechanisms; hence, we collectively refer to them as endoscopic cardia peripheral tissue scar formation (ECSF). We conducted a systematic review and meta-analysis to assess the safety and efficacy of ECSF in treating rGERD.
METHODS: We performed a comprehensive search of several databases, including PubMed, Embase, Medline, China Knowledge Network, and Wanfang, to ensure a systematic approach for data collection between January 2011 and July 2023. Forest plots were used to summarize and combine the GERD-health-related quality of life (HRQL), gastroesophageal reflux questionnaire score, and DeMeester scores, acid exposure time, lower esophageal sphincter pressure, esophagitis, proton pump inhibitors use, and patient satisfaction.
RESULTS: This study comprised 37 studies, including 1732 patients. After ECSF, significant improvement in gastroesophageal reflux disease health-related quality of life score (mean difference [MD] = 18.27 95% CI: 14.81-21.74), gastroesophageal reflux questionnaire score (MD = 4.85 95% CI: 3.96-5.75), DeMeester score (MD = 42.34, 95% CI: 31.37-53.30), acid exposure time (MD = 7.98, 95% CI: 6.03-9.92), and lower esophageal sphincter pressure was observed (MD = -5.01, 95% CI: -8.39 to 1.62). The incidence of serious adverse effects after ECSF was 1.1% (95% CI: 0.9%-1.2%), and postoperatively, 67.4% (95% CI: 66.4%-68.2%) of patients could discontinue proton pump inhibitor-like drugs, and the treatment outcome was observed to be satisfactory in over 80% of the patients. Subgroup analyses of the various procedures showed that all 3 types improved several objective or subjective patient indicators.
CONCLUSIONS: Based on the current meta-analysis, we conclude that rGERD can be safely and effectively treated with ECSF as an endoscopic procedure.
METHODS: We performed a comprehensive search of several databases, including PubMed, Embase, Medline, China Knowledge Network, and Wanfang, to ensure a systematic approach for data collection between January 2011 and July 2023. Forest plots were used to summarize and combine the GERD-health-related quality of life (HRQL), gastroesophageal reflux questionnaire score, and DeMeester scores, acid exposure time, lower esophageal sphincter pressure, esophagitis, proton pump inhibitors use, and patient satisfaction.
RESULTS: This study comprised 37 studies, including 1732 patients. After ECSF, significant improvement in gastroesophageal reflux disease health-related quality of life score (mean difference [MD] = 18.27 95% CI: 14.81-21.74), gastroesophageal reflux questionnaire score (MD = 4.85 95% CI: 3.96-5.75), DeMeester score (MD = 42.34, 95% CI: 31.37-53.30), acid exposure time (MD = 7.98, 95% CI: 6.03-9.92), and lower esophageal sphincter pressure was observed (MD = -5.01, 95% CI: -8.39 to 1.62). The incidence of serious adverse effects after ECSF was 1.1% (95% CI: 0.9%-1.2%), and postoperatively, 67.4% (95% CI: 66.4%-68.2%) of patients could discontinue proton pump inhibitor-like drugs, and the treatment outcome was observed to be satisfactory in over 80% of the patients. Subgroup analyses of the various procedures showed that all 3 types improved several objective or subjective patient indicators.
CONCLUSIONS: Based on the current meta-analysis, we conclude that rGERD can be safely and effectively treated with ECSF as an endoscopic procedure.
摘要：
背景：内镜治疗越来越多地用于难治性胃食管反流病（rGERD）。与传统外科胃底折叠术的机制不同，胃食管连接处结扎，抗反流粘膜干预，和射频消融具有极其相似的抗反流机制；因此，我们统称为内镜贲门周围组织瘢痕形成(ECSF).我们进行了系统评价和荟萃分析，以评估ECSF治疗rGERD的安全性和有效性。
方法：我们对多个数据库进行了全面搜索，包括PubMed,Embase,Medline,中国知网,还有万方,确保在2011年1月至2023年7月之间采取系统的数据收集方法。森林地块被用来总结和结合GERD-健康相关的生活质量(HRQL)，胃食管反流问卷评分,和DeMeester得分,酸暴露时间，食管下括约肌压力,食管炎,质子泵抑制剂的使用，患者满意度。
结果：这项研究包括37项研究，包括1732名患者。在ECSF之后,胃食管反流病健康相关生活质量评分显著改善(平均差异[MD]=18.2795%CI:14.81-21.74),胃食管反流问卷评分（MD=4.8595％CI：3.96-5.75），DeMeester评分（MD=42.34，95%CI：31.37-53.30），酸暴露时间（MD=7.98，95%CI：6.03-9.92），观察到食管下括约肌压（MD=-5.01，95％CI：-8.39至1.62）。ECSF术后严重不良反应发生率为1.1%(95%CI:0.9%-1.2%),术后，67.4%(95%CI:66.4%-68.2%)的患者可以停用质子泵抑制剂类药物,80%以上的患者的治疗结果令人满意。各种程序的亚组分析表明，所有3种类型都改善了一些客观或主观的患者指标。
结论：基于当前的荟萃分析，我们得出的结论是,将ECSF作为内镜手术,可以安全有效地治疗rGERD.
方法：我们对多个数据库进行了全面搜索，包括PubMed,Embase,Medline,中国知网,还有万方,确保在2011年1月至2023年7月之间采取系统的数据收集方法。森林地块被用来总结和结合GERD-健康相关的生活质量(HRQL)，胃食管反流问卷评分,和DeMeester得分,酸暴露时间，食管下括约肌压力,食管炎,质子泵抑制剂的使用，患者满意度。
结果：这项研究包括37项研究，包括1732名患者。在ECSF之后,胃食管反流病健康相关生活质量评分显著改善(平均差异[MD]=18.2795%CI:14.81-21.74),胃食管反流问卷评分（MD=4.8595％CI：3.96-5.75），DeMeester评分（MD=42.34，95%CI：31.37-53.30），酸暴露时间（MD=7.98，95%CI：6.03-9.92），观察到食管下括约肌压（MD=-5.01，95％CI：-8.39至1.62）。ECSF术后严重不良反应发生率为1.1%(95%CI:0.9%-1.2%),术后，67.4%(95%CI:66.4%-68.2%)的患者可以停用质子泵抑制剂类药物,80%以上的患者的治疗结果令人满意。各种程序的亚组分析表明，所有3种类型都改善了一些客观或主观的患者指标。
结论：基于当前的荟萃分析，我们得出的结论是,将ECSF作为内镜手术,可以安全有效地治疗rGERD.
