Abstract：
BACKGROUND: There are no direct comparisons across different endoscopic therapies for gastroesophageal reflux disease (GERD). This study aimed to evaluate the relative effects of different endoscopic therapies in GERD.
METHODS: Five databases were searched until August 2023 for randomized controlled trials (RCTs) that compared the efficacy of endoscopic band ligation (EBL), Stretta, endoscopic fundoplication (transoral incisionless fundoplication [TIF], endoscopic full-thickness plication [EFTP], and EndoCinch plication procedure [EndoCinch, CR BARD, Billerica, Mass., USA]), or proton pump inhibitors (PPIs)/sham procedure for GERD. Bayesian network meta-analysis was performed.
RESULTS: A total of 19 trials comprising 1181 patients were included. EBL (mean difference [MD], -7.75; 95% credible interval [CrI], -13.90 to -1.44), Stretta (MD, -9.86; 95% CrI, -19.05 to -0.58), and TIF (MD, -12.58; 95% CrI, -20.23 to -4.91) all significantly improved patients\' health-related quality of life score with equivalent efficacy compared with PPIs. TIF and EBL achieved equivalent efficacy in reducing PPIs utility (risk ratio [RR], 0.66; 95% CrI, 0.40-1.05) and both were significantly superior to other endoscopic interventions (Stretta, EFTP, and EndoCinch). Besides, EBL and TIF also could significantly decrease the esophagitis incidence compared with PPIs (EBL [RR, 0.34; 95% CrI, 0.22-0.48] and TIF [RR, 0.38; 95% CrI, 0.15-0.88]). In terms of lower esophageal sphincter (LES) pressure, only TIF could significantly increase the LES pressure (MD, 6.53; 95% CrI, 3.65-9.40) to PPIs. In contrast, TIF was inferior to PPIs in decreasing esophageal acid exposure (MD, 2.57; 95% CrI, 0.77-4.36).
CONCLUSIONS: Combining the evidence, EBL and TIF may have comparable efficacy and both might be superior to Stretta, EFTP, or EndoCinch in GERD treatment.
METHODS: Five databases were searched until August 2023 for randomized controlled trials (RCTs) that compared the efficacy of endoscopic band ligation (EBL), Stretta, endoscopic fundoplication (transoral incisionless fundoplication [TIF], endoscopic full-thickness plication [EFTP], and EndoCinch plication procedure [EndoCinch, CR BARD, Billerica, Mass., USA]), or proton pump inhibitors (PPIs)/sham procedure for GERD. Bayesian network meta-analysis was performed.
RESULTS: A total of 19 trials comprising 1181 patients were included. EBL (mean difference [MD], -7.75; 95% credible interval [CrI], -13.90 to -1.44), Stretta (MD, -9.86; 95% CrI, -19.05 to -0.58), and TIF (MD, -12.58; 95% CrI, -20.23 to -4.91) all significantly improved patients\' health-related quality of life score with equivalent efficacy compared with PPIs. TIF and EBL achieved equivalent efficacy in reducing PPIs utility (risk ratio [RR], 0.66; 95% CrI, 0.40-1.05) and both were significantly superior to other endoscopic interventions (Stretta, EFTP, and EndoCinch). Besides, EBL and TIF also could significantly decrease the esophagitis incidence compared with PPIs (EBL [RR, 0.34; 95% CrI, 0.22-0.48] and TIF [RR, 0.38; 95% CrI, 0.15-0.88]). In terms of lower esophageal sphincter (LES) pressure, only TIF could significantly increase the LES pressure (MD, 6.53; 95% CrI, 3.65-9.40) to PPIs. In contrast, TIF was inferior to PPIs in decreasing esophageal acid exposure (MD, 2.57; 95% CrI, 0.77-4.36).
CONCLUSIONS: Combining the evidence, EBL and TIF may have comparable efficacy and both might be superior to Stretta, EFTP, or EndoCinch in GERD treatment.
摘要：
目的：胃食管反流病（GERD）的不同内镜治疗方法之间没有直接比较。本研究旨在评估不同内镜治疗GERD的相对效果。
方法：直到2023年8月，在五个数据库中搜索了比较内窥镜带结扎（EBL）疗效的RCT，Stretta,内镜胃底折叠术（经口无切口胃底折叠术（TIF），内镜全层放置（EFTP），endoCinch折叠程序（EndoCinch））或用于GERD的PPI/假手术。进行贝叶斯网络荟萃分析。
结果：包括1181例患者的19项试验。EBL（MD：-7.75；95％CrI：-13.90至-1.44），Stretta(MD:-9.86;95%CrI:-19.05至-0.58),和TIF（MD：-12.58;95％CrI：-20.23至-4.91）均显着改善了患者的健康相关生活质量（HRQL）评分，具有同等疗效，与PPI相比。TIF和EBL在降低PPI效用方面取得了同等疗效（RR：0.66；95％CrI：0.40至1.05），并且均显着优于其他内窥镜干预措施（Stretta，EFTP,和EndoCinch）。此外,与PPI相比，EBL和TIF也可以显着降低食管炎的发生率（EBL（RR：0.34；95％CrI：0.22至0.48），TIF(RR:0.38;95%CrI:0.15至0.88))。在食管下括约肌（LES）压力方面，只有TIF可以显着增加LES压力（MD：6.53;95％CrI：3.65至9.40）给PPI。相比之下,TIF在减少食管酸暴露方面劣于PPI（MD：2.57；95％CrI：0.77至4.36）。
结论：结合证据，EBL和TIF可能具有相当的疗效，两者都可能优于Stretta，EFTP或EndoCinch在GERD治疗中的应用。
方法：直到2023年8月，在五个数据库中搜索了比较内窥镜带结扎（EBL）疗效的RCT，Stretta,内镜胃底折叠术（经口无切口胃底折叠术（TIF），内镜全层放置（EFTP），endoCinch折叠程序（EndoCinch））或用于GERD的PPI/假手术。进行贝叶斯网络荟萃分析。
结果：包括1181例患者的19项试验。EBL（MD：-7.75；95％CrI：-13.90至-1.44），Stretta(MD:-9.86;95%CrI:-19.05至-0.58),和TIF（MD：-12.58;95％CrI：-20.23至-4.91）均显着改善了患者的健康相关生活质量（HRQL）评分，具有同等疗效，与PPI相比。TIF和EBL在降低PPI效用方面取得了同等疗效（RR：0.66；95％CrI：0.40至1.05），并且均显着优于其他内窥镜干预措施（Stretta，EFTP,和EndoCinch）。此外,与PPI相比，EBL和TIF也可以显着降低食管炎的发生率（EBL（RR：0.34；95％CrI：0.22至0.48），TIF(RR:0.38;95%CrI:0.15至0.88))。在食管下括约肌（LES）压力方面，只有TIF可以显着增加LES压力（MD：6.53;95％CrI：3.65至9.40）给PPI。相比之下,TIF在减少食管酸暴露方面劣于PPI（MD：2.57；95％CrI：0.77至4.36）。
结论：结合证据，EBL和TIF可能具有相当的疗效，两者都可能优于Stretta，EFTP或EndoCinch在GERD治疗中的应用。
