目的:我们旨在回顾和定量比较腹腔镜Toupet胃底折叠术(LTF),尼森胃底折叠术(LNF),前部分胃底折叠术(APF),磁增强括约肌(MSA),射频消融(RFA),经口无切口胃底折叠术(TIF),质子泵抑制剂(PPI),和安慰剂治疗GERD。许多荟萃分析比较了手术和内镜手术治疗顽固性GERD的疗效,但是关于执行策略的有效性仍有相当多的争论。
方法:对MEDLINE数据库的系统评价,EMBASE,和WebofScience进行随机对照试验(RCTs),比较上述手术和内镜GERD治疗方法.风险比和加权平均差被用作合并效应大小度量,而95%可信区间(CrI)用于评估相对推断。
结果:纳入33个随机对照试验。手术和内窥镜治疗对胃灼热有相似的RR,返流,腹胀.与APF(RR3.3;Crl1.4-7.1)和LNF(RR2.5;Crl1.3-4.4)相比,LTF术后吞咽困难的RR较低。合并网络荟萃分析未观察到LES压力和pH<相对于基线的任何显著改善。LTF,APF,LNF,MSA,RFA,和TIF有相似的术后PPI停药率。
结论:与APF和LNF相比,LTF术后吞咽困难的发生率较低。pre-posteffects,例如GERD-HQRL,LES压力,和pH<4,应避免在荟萃分析,因为结果可能有偏差。最后,需要就GERD治疗的疗效及其结局评估达成共识.
OBJECTIVE: We aim to review and quantitatively compare laparoscopic Toupet fundoplication (LTF), Nissen fundoplication (LNF), anterior partial fundoplication (APF), magnetic augmentation sphincter (MSA), radiofrequency ablation (RFA), transoral incisionless fundoplication (TIF), proton pump inhibitor (PPI), and placebo for the treatment of GERD. A number of meta-analyses compared the efficacy of surgical and endoscopic procedures for recalcitrant GERD, but considerable debate on the effectiveness of operative strategies remains.
METHODS: A systematic review of MEDLINE databases, EMBASE, and Web of Science for randomized controlled trials (RCTs) comparing the aforementioned surgical and endoscopic GERD treatments was performed. Risk ratio and weighted mean difference were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference.
RESULTS: Thirty-three RCTs were included. Surgical and endoscopic treatments have similar RR for heartburn, regurgitation, bloating. LTF has a lower RR of post-operative dysphagia when compared to APF (RR 3.3; Crl 1.4-7.1) and LNF (RR 2.5; Crl 1.3-4.4). The pooled network meta-analysis did not observe any significant improvement regarding LES pressure and pH < from baseline. LTF, APF, LNF, MSA, RFA, and TIF had have a similar post-operative PPI discontinuation rate.
CONCLUSIONS: LTF has a lower rate of post-operative dysphagia when compared to APF and LNF. The pre-post effects, such as GERD-HQRL, LES pressure, and pH <4, should be avoided in meta-analyses because results may be biased. Last, a consensus about the evaluation of GERD treatments\' efficacy and their outcomes is needed.