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Abstract：
OBJECTIVE: Barrett\'s esophagus (BE) is a precancerous condition that has the potential to develop into esophageal cancer (EC). Currently, there is a wide range of management options available for individuals at different pathological stages in Barrett\'s esophagus (BE). However, there is currently a lack of knowledge regarding their comparative efficacy. To address this gap, we conducted a network meta-analysis of published randomized controlled trials to examine the comparative effectiveness of all regimens.
METHODS: Data extracted from eligible randomized controlled trials were utilized in a Bayesian network meta-analysis to examine the relative effectiveness of BE\'s treatment regimens and determine their ranking in terms of efficacy. The ranking probability for each regimen was assessed using the surfaces under cumulative ranking values. The outcomes under investigation were complete ablation of BE, neoplastic progression of BE, and complete eradication of dysplasia.
RESULTS: We identified twenty-three RCT studies with a total of 1675 participants, and ten different interventions. Regarding complete ablation of non-dysplastic BE, the comparative effectiveness ranking indicated that argon plasma coagulation (APC) was the most effective regimen, with the highest SUCRA value, while surveillance and PPI/H2RA were found to be the least efficacious regimens. For complete ablation of BE with low-grade dysplasia, high-grade dysplasia, or esophageal cancer, photodynamic therapy (PDT) had the highest SUCRA value of 94.1%, indicating it as the best regimen. Additionally, for complete eradication of dysplasia, SUCRA plots showed a trend in ranking PDT as the highest with a SUCRA value of 91.2%. Finally, for neoplastic progression, radiofrequency ablation (RFA) and surgery were found to perform significantly better than surveillance. The risk of bias assessment revealed that 6 studies had an overall high risk of bias. However, meta-regression with risk of bias as a covariate did not indicate any influence on the model. In terms of the Confidence in Network Meta-Analysis evaluation, a high level of confidence was found for all treatment comparisons.
CONCLUSIONS: Endoscopic surveillance alone or PPI/H2RA alone may not be sufficient for managing BE, even in cases of non-dysplastic BE. However, APC has shown excellent efficacy in treating non-dysplastic BE. For cases of BE with low-grade dysplasia, high-grade dysplasia, or esophageal cancer, PDT may be the optimal intervention as it can induce regression of BE metaplasia and prevent future progression of BE to dysplasia and EC.
METHODS: Data extracted from eligible randomized controlled trials were utilized in a Bayesian network meta-analysis to examine the relative effectiveness of BE\'s treatment regimens and determine their ranking in terms of efficacy. The ranking probability for each regimen was assessed using the surfaces under cumulative ranking values. The outcomes under investigation were complete ablation of BE, neoplastic progression of BE, and complete eradication of dysplasia.
RESULTS: We identified twenty-three RCT studies with a total of 1675 participants, and ten different interventions. Regarding complete ablation of non-dysplastic BE, the comparative effectiveness ranking indicated that argon plasma coagulation (APC) was the most effective regimen, with the highest SUCRA value, while surveillance and PPI/H2RA were found to be the least efficacious regimens. For complete ablation of BE with low-grade dysplasia, high-grade dysplasia, or esophageal cancer, photodynamic therapy (PDT) had the highest SUCRA value of 94.1%, indicating it as the best regimen. Additionally, for complete eradication of dysplasia, SUCRA plots showed a trend in ranking PDT as the highest with a SUCRA value of 91.2%. Finally, for neoplastic progression, radiofrequency ablation (RFA) and surgery were found to perform significantly better than surveillance. The risk of bias assessment revealed that 6 studies had an overall high risk of bias. However, meta-regression with risk of bias as a covariate did not indicate any influence on the model. In terms of the Confidence in Network Meta-Analysis evaluation, a high level of confidence was found for all treatment comparisons.
CONCLUSIONS: Endoscopic surveillance alone or PPI/H2RA alone may not be sufficient for managing BE, even in cases of non-dysplastic BE. However, APC has shown excellent efficacy in treating non-dysplastic BE. For cases of BE with low-grade dysplasia, high-grade dysplasia, or esophageal cancer, PDT may be the optimal intervention as it can induce regression of BE metaplasia and prevent future progression of BE to dysplasia and EC.
摘要：
目的：Barrett食管（BE）是一种癌前病变，有可能发展为食管癌（EC）。目前,对于Barrett食管(BE)不同病理阶段的患者,有多种治疗方案.然而,目前缺乏有关其比较功效的知识。为了解决这个差距，我们对已发表的随机对照试验进行了网络荟萃分析,以检验所有治疗方案的比较有效性.
方法：从符合条件的随机对照试验中提取的数据用于贝叶斯网络荟萃分析，以检查BE治疗方案的相对有效性，并确定其在疗效方面的排名。使用累积排序值下的表面评估每个方案的排序概率。研究结果为BE完全消融，BE的肿瘤进展，彻底根除发育不良。
结果：我们确定了23项RCT研究，共有1675名参与者，十种不同的干预措施。关于非发育不良BE的完全消融，疗效比较排名表明，氩离子凝固术(APC)是最有效的方案，具有最高的SUCRA值，而监测和PPI/H2RA被发现是效果最差的方案。对于低级别发育不良的BE完全消融,高度发育不良,或者食道癌，光动力疗法(PDT)的SUCRA值最高，为94.1%，表明它是最好的方案。此外,为了彻底根除发育不良，SUCRA图显示出将PDT列为最高的趋势，SUCRA值为91.2％。最后,肿瘤进展，研究发现,射频消融(RFA)和手术的效果明显优于监测.偏倚风险评估显示，6项研究总体偏倚风险较高。然而,以偏倚风险为协变量的meta回归未显示对模型有任何影响.在网络元分析评价的信心方面，所有治疗比较均有较高的可信度.
结论：单独的内镜监测或单独的PPI/H2RA可能不足以管理BE，即使在非发育不良的情况下。然而,APC在治疗非发育不良BE中显示出优异的功效。对于低级别发育不良的BE病例，高度发育不良,或者食道癌，PDT可能是最佳的干预措施，因为它可以诱导BE上皮化生的消退，并阻止BE向发育异常和EC的未来进展。
方法：从符合条件的随机对照试验中提取的数据用于贝叶斯网络荟萃分析，以检查BE治疗方案的相对有效性，并确定其在疗效方面的排名。使用累积排序值下的表面评估每个方案的排序概率。研究结果为BE完全消融，BE的肿瘤进展，彻底根除发育不良。
结果：我们确定了23项RCT研究，共有1675名参与者，十种不同的干预措施。关于非发育不良BE的完全消融，疗效比较排名表明，氩离子凝固术(APC)是最有效的方案，具有最高的SUCRA值，而监测和PPI/H2RA被发现是效果最差的方案。对于低级别发育不良的BE完全消融,高度发育不良,或者食道癌，光动力疗法(PDT)的SUCRA值最高，为94.1%，表明它是最好的方案。此外,为了彻底根除发育不良，SUCRA图显示出将PDT列为最高的趋势，SUCRA值为91.2％。最后,肿瘤进展，研究发现,射频消融(RFA)和手术的效果明显优于监测.偏倚风险评估显示，6项研究总体偏倚风险较高。然而,以偏倚风险为协变量的meta回归未显示对模型有任何影响.在网络元分析评价的信心方面，所有治疗比较均有较高的可信度.
结论：单独的内镜监测或单独的PPI/H2RA可能不足以管理BE，即使在非发育不良的情况下。然而,APC在治疗非发育不良BE中显示出优异的功效。对于低级别发育不良的BE病例，高度发育不良,或者食道癌，PDT可能是最佳的干预措施，因为它可以诱导BE上皮化生的消退，并阻止BE向发育异常和EC的未来进展。
