Abstract：
BACKGROUND: Studies have evaluated the efficacy of endoscopic incisional therapy (EIT) for benign anastomotic strictures. We performed a systematic review and meta-analysis to evaluate stricture recurrence after EIT following esophagectomy or gastrectomy.
METHODS: A systematic search of databases was performed up to April 2nd, 2023, after selection of key search terms with the research team. Inclusion criteria included human participants undergoing EIT for a benign anastomotic stricture after esophagectomy or gastrectomy, age ≥ 18, and n ≥ 5. Our primary outcome was the incidence of stricture recurrence among patients treated with EIT compared to dilation. Our secondary outcome was the stricture-free duration after EIT and rate of adverse events. Meta-analysis was performed with RevMan 5.4.1 using a Mantel-Haenszel random-effects model. Publication bias was evaluated with funnel plots and the Egger test.
RESULTS: A total of 2550 unique preliminary studies underwent screening of abstracts and titles. This led to 33 studies which underwent full-text review and five studies met the inclusion criteria. Meta-analysis revealed reduced odds of overall stricture recurrence (OR 0.35, 95% CI 0.13-0.92, p = 0.03; I2 = 71%) and reduced odds of stricture recurrence among naïve strictures (OR 0.32, 95% CI 0.17-0.59, p = 0.0003; I2 = 0%) for patients undergoing EIT compared to dilation. There was no significant difference in the odds of stricture recurrence among recurrent strictures (OR 0.63, 95% CI 0.12-3.28, p = 0.58; I2 = 81%). Meta-analysis revealed a significant increase in the recurrence-free duration (MD 42.76, 95% CI 12.41-73.11, p = 0.006) among patients undergoing EIT compared to dilation.
CONCLUSIONS: Current data suggest EIT is associated with reduced odds of stricture recurrence among naïve anastomotic strictures. Large, prospective studies are needed to characterize the safety profile of EIT, address publication bias, and to explore multimodal therapies for refractory strictures.
METHODS: A systematic search of databases was performed up to April 2nd, 2023, after selection of key search terms with the research team. Inclusion criteria included human participants undergoing EIT for a benign anastomotic stricture after esophagectomy or gastrectomy, age ≥ 18, and n ≥ 5. Our primary outcome was the incidence of stricture recurrence among patients treated with EIT compared to dilation. Our secondary outcome was the stricture-free duration after EIT and rate of adverse events. Meta-analysis was performed with RevMan 5.4.1 using a Mantel-Haenszel random-effects model. Publication bias was evaluated with funnel plots and the Egger test.
RESULTS: A total of 2550 unique preliminary studies underwent screening of abstracts and titles. This led to 33 studies which underwent full-text review and five studies met the inclusion criteria. Meta-analysis revealed reduced odds of overall stricture recurrence (OR 0.35, 95% CI 0.13-0.92, p = 0.03; I2 = 71%) and reduced odds of stricture recurrence among naïve strictures (OR 0.32, 95% CI 0.17-0.59, p = 0.0003; I2 = 0%) for patients undergoing EIT compared to dilation. There was no significant difference in the odds of stricture recurrence among recurrent strictures (OR 0.63, 95% CI 0.12-3.28, p = 0.58; I2 = 81%). Meta-analysis revealed a significant increase in the recurrence-free duration (MD 42.76, 95% CI 12.41-73.11, p = 0.006) among patients undergoing EIT compared to dilation.
CONCLUSIONS: Current data suggest EIT is associated with reduced odds of stricture recurrence among naïve anastomotic strictures. Large, prospective studies are needed to characterize the safety profile of EIT, address publication bias, and to explore multimodal therapies for refractory strictures.
摘要：
背景：研究已经评估了内镜下切口治疗（EIT）对良性吻合口狭窄的疗效。我们进行了系统评价和荟萃分析，以评估食管切除术或胃切除术后EIT狭窄的复发。
方法：对数据库进行了系统搜索，直到4月2日，2023年，在与研究团队一起选择关键搜索词后。纳入标准包括因食管切除术或胃切除术后良性吻合口狭窄而接受EIT的人类参与者，年龄≥18岁，n≥5岁。我们的主要结果是与扩张相比，接受EIT治疗的患者狭窄复发的发生率。我们的次要结果是EIT后无狭窄持续时间和不良事件发生率。采用Mantel-Haenszel随机效应模型对RevMan5.4.1进行Meta分析。用漏斗图和Egger检验评估发表偏差。
结果：共有2550项独特的初步研究进行了摘要和标题筛选。这导致33项研究进行了全文回顾，其中5项研究符合纳入标准。荟萃分析显示，与扩张相比，接受EIT的患者总体狭窄复发的几率降低（OR0.35，95％CI0.13-0.92，p=0.03；I2=71％），而未治疗狭窄的复发几率降低（OR0.32，95％CI0.17-0.59，p=0.0003；I2=0％）。复发狭窄的狭窄复发几率没有显着差异（OR0.63，95％CI0.12-3.28，p=0.58；I2=81％）。荟萃分析显示，与扩张相比，接受EIT的患者的无复发持续时间显着增加（MD42.76，95％CI12.41-73.11，p=0.006）。
结论：目前的数据表明，在初治吻合口狭窄中，EIT与狭窄复发几率降低相关。大,需要前瞻性研究来描述EIT的安全性，解决出版偏见，并探索难治性狭窄的多模式疗法。
方法：对数据库进行了系统搜索，直到4月2日，2023年，在与研究团队一起选择关键搜索词后。纳入标准包括因食管切除术或胃切除术后良性吻合口狭窄而接受EIT的人类参与者，年龄≥18岁，n≥5岁。我们的主要结果是与扩张相比，接受EIT治疗的患者狭窄复发的发生率。我们的次要结果是EIT后无狭窄持续时间和不良事件发生率。采用Mantel-Haenszel随机效应模型对RevMan5.4.1进行Meta分析。用漏斗图和Egger检验评估发表偏差。
结果：共有2550项独特的初步研究进行了摘要和标题筛选。这导致33项研究进行了全文回顾，其中5项研究符合纳入标准。荟萃分析显示，与扩张相比，接受EIT的患者总体狭窄复发的几率降低（OR0.35，95％CI0.13-0.92，p=0.03；I2=71％），而未治疗狭窄的复发几率降低（OR0.32，95％CI0.17-0.59，p=0.0003；I2=0％）。复发狭窄的狭窄复发几率没有显着差异（OR0.63，95％CI0.12-3.28，p=0.58；I2=81％）。荟萃分析显示，与扩张相比，接受EIT的患者的无复发持续时间显着增加（MD42.76，95％CI12.41-73.11，p=0.006）。
结论：目前的数据表明，在初治吻合口狭窄中，EIT与狭窄复发几率降低相关。大,需要前瞻性研究来描述EIT的安全性，解决出版偏见，并探索难治性狭窄的多模式疗法。
