内镜下治疗胃食管反流病的网状Meta分析

A network Meta-analysis of endoscopic treatment of gastroesophageal reflux disease

摘要:

目的 射频消融术（RF）、经口无切口胃底折叠术（TIF）和抗反流黏膜切除术（ARMS）是治疗胃食管反流病（GERD）的3种内镜下治疗方式，但目前缺少直接比较研究来证明哪种手术方式最佳，该文应用网状Meta分析方法，比较不同内镜下治疗方法的临床疗效。方法 搜索中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普（VIP）、万方数据（WanFang Data）、Cochrane图书馆、PubMed、Embase和Medline，自建库至2021年12月1日公开发表的符合纳入标准的随机对照试验（RCT）类文献，并根据Cochrane 5.1手册标准评估纳入文献的质量和偏倚风险。通过RevMan 5.4软件、ADDIS 16.6软件及Stata 19.0软件进行质量评价和网络分析。结果 ①共纳入16项研究，总计950例患者：对照组采用质子泵抑制剂（PPI）治疗或假手术（Sham）治疗，实验组采用RF、TIF或ARMS治疗；②文献质量评价结果显示，11篇文献为高质量文献，其他5篇文献为低质量文献；③网状Meta排序结果显示：在停止服药人数方面，ARMS效果最佳，之后依次是RF和TIF；在pH < 4.2的酸反流时间方面，ARMS效果最佳，之后依次是RF和TIF；在控制食管下段压力方面，ARMS效果最佳，之后依次是TIF和RF；在健康相关生活质量（HRQL）评分方面，ARMS效果最佳，之后依次是TIF和RF。结论 3种内镜下治疗方法的临床试验表明，ARMS在停止服药人数、pH < 4.2的酸反流时间、增加食管下段压力和改善HRQL评分方面均为最优，可作为GERD非药物治疗的首选治疗方案。

Abstract:

Objective Currently, radiofrequency ablation (RF), transoral incisionless fundoplication (TIF), and anti-reflux mucosectomy (ARMS) are the main endoscopic treatment methods for gastroesophageal reflux disease (GERD). However, there is still a lack of direct comparison between any of the two methods to prove the best surgical method. The article uses the network Meta-analysis method to compare the efficacy of three endoscopic treatment methods in the treatment of GERD.Methods CBM, CNKI, VIP, WanFang Data, Cochrane Library, PubMed, Embase and Medline were comprehensively searched. Search for randomized controlled trial (RCT) of RF, TIF, and ARMS for GERD published before December 1, 2021. Articles that met the inclusion criteria were screened and the quality of the literature and the risk of bias were assessed according to the Cochrane 5.1 manual criteria. Network analysis and order ranking were performed using RevMan 5.4 software, ADDIS 16.6 software and Stata 19.0 software.Results 950 patients were included in 16 studies. The control group was treated with proton pump inhibitor (PPI) or Sham surgery, and the experimental group was treated with RF, TIF or ARMS; The quality evaluation results of the included literatures showed that 11 literatures were high quality, and the other 5 literatures were low quality; The net-work Meta ranking results show that ARMS has the best effect in stopping medication, followed by RF, and TIF is relatively poor; In terms of acid reflux time of pondus hydrogenii (pH) < 4.2, ARMS has the best effect, followed by RF, and TIF is relatively Poor; ARMS has the best effect in controlling lower esophageal pressure, followed by TIF, and RF is relatively poor; In terms of health-related quality of life (HRQL) scores, ARMS has the best effect, followed by TIF, and RF is relatively poor.Conclusion Evidence from clinical trials on the three endoscopic treatment methods shows that ARMS is the best in the above four aspects, and can be used as the first choice for non-drug treatment of GERD.