目的:粘膜切口辅助活检(MIAB)用于上皮下病变(SEL)的组织采集(TA)正在成为内窥镜超声(EUS)引导的TA的替代方法。只有有限数量的研究比较了MIAB和EUS对上消化道(GI)SELs的诊断效用;因此,我们进行了系统综述和荟萃分析.
方法:从2020年1月至2022年1月进行了全面的文献检索,以比较MIAB和EUS指导的TA对上GISEL的诊断准确性和安全性。
结果:本荟萃分析纳入了7项研究。合并技术成功率(风险比[RR],0.96;95%置信区间[CI],0.89-1.04)和手术时间(平均差异=-4.53秒;95%CI,-22.38至13.31]在两组之间具有可比性。对于所有病变,EUS获得阳性诊断率的总体机会低于MIAB(RR,0.83;95%CI,0.71-0.98),但使用细针活检针时具有可比性(RR,0.93;95%CI,0.83-1.04)。对于<20mm的病变,MIAB的阳性诊断率更高(RR,0.75;95%CI,0.63-0.89)。6项研究报告无不良事件。
结论:MIAB可以被认为是EUS指导的TA治疗上消化道SEL的有效替代方案,而不会增加不良事件的风险。
OBJECTIVE: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic
review and meta-analysis.
METHODS: A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs.
RESULTS: Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89-1.04) and procedural time (mean difference=-4.53 seconds; 95% CI, -22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71-0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83-1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63-0.89). Six studies reported no adverse events.
CONCLUSIONS: MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.