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.
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。