目的:内镜切除术是治疗早期Barrett瘤形成的首选方法,减少手术干预的需要。然而,内镜黏膜下切除术(EMR)或内镜黏膜下剥离术(ESD)的最佳选择尚不清楚.该研究旨在比较EMR与EMR的疗效和安全性。早期巴雷特瘤形成的ESD。
方法:在MEDLINE进行了电子搜索,中央Cochrane,EMBASE,和LILACS直到2023年11月。比较ESD与ESD的研究包括早期Barrett瘤形成患者的EMR治疗。这项研究是根据系统评价和荟萃分析指南的首选报告项目进行的。使用ROBIN-I工具分析偏倚风险和GRADE来衡量证据质量。
结果:共纳入来自15项观察性研究的9352名患者。接受ESD的患者的整体发生率(比值比[OR]25.96,95%置信区间[CI]13.82,48.74;I2=52%;P<0.00001)和R0(OR5.10,95%CI3.29,7.91;I2=73%;P<0.00001)明显更高,不良事件的风险更高。包括出血,狭窄形成,和穿孔。在未接受射频消融的患者的亚组分析中,ESD的复发率低于EMR(OR0.22,95%CI0.05,0.94;I2=88%;P=0.04)。
结论:内镜黏膜下剥离术在治疗早期Barrett瘤形成方面比EMR更有效,但不良事件发生率更高。
OBJECTIVE: Endoscopic resection is the preferred approach to treat early Barrett\'s neoplasia, reducing the need for surgical interventions. However, the best choice between endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) remains unclear. The study aimed to compare the efficacy and safety of EMR vs. ESD for early Barrett\'s neoplasia.
METHODS: An electronic search was conducted in MEDLINE, Central Cochrane, EMBASE, and LILACS until November 2023. Studies comparing ESD vs. EMR in the treatment of patients with early Barrett\'s neoplasia were included. This study was performed according to the Preferred Report Items for Systematic Reviews and Meta-Analyses guidelines. The ROBIN-I tool was used to analyze the risk of bias and GRADE to measure the quality of the evidence.
RESULTS: A total of 9352 patients from 15 observational studies were included. Patients undergoing ESD had significantly higher rates of en-bloc (odds ratio [OR] 25.96, 95% confidence interval [CI] 13.82, 48.74; I2 = 52%; P < 0.00001) and R0 (OR 5.10, 95% CI 3.29, 7.91; I2 = 73%; P < 0.00001) with a higher risk of adverse events, including bleeding, stricture formation, and perforation. In a subgroup analysis of patients who did not receive radiofrequency ablation, ESD had a lower recurrence rate than EMR (OR 0.22, 95% CI 0.05, 0.94; I2 = 88%; P = 0.04).
CONCLUSIONS: Endoscopic submucosal dissection is more effective than EMR in treating early Barrett\'s neoplasia at the expense of higher adverse events rates.