Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT, United States of America.
Yale University School of Medicine, New Haven, CT, United States of America.
Am J Otolaryngol. 2021 Sep-Oct;42(5):103128. doi: 10.1016/j.amjoto.2021.103128. Epub 2021 Jun 18.
Esophageal dilation (ED) may be performed in the office under local anesthesia or in a procedure/operating room under general anesthesia or intravenous (IV) sedation. However, indications for type of anesthesia during these procedures have not been established. The purpose of this review is to assess outcomes of esophageal dilation performed using different types of anesthesia to assess the safety of office-based techniques.
We conducted a systematic review and meta-analysis comparing the outcomes of anesthesia techniques for ED in adults. Exclusion criteria included reviews, small case series, use of stents, diagnoses with high morbidity, and rare diseases. A comprehensive literature search of the PubMed, CINAHL, and EMBASE databases was performed for articles relating to esophageal dilation.
876 papers were identified of which 164 full text studies were assessed and 25 were included in the analysis using the PRISMA guidelines. Data regarding demographics, dilation technique, and adverse events were extracted. The DerSimonian-Laird random-effect models with inverse-variance weighting were fit to estimate the combined effects. There were no statistically significant differences among mortality, perforation, or bleeding based on anesthetic.
With office-based procedures gaining popularity in laryngology, there is a need to profile their safety. Office-based ED appears to have equivalent safety to general and IV sedation, although further research is necessary to define indications favoring office-based techniques.
食管扩张术（ED）可在局麻下于诊室进行，也可在全麻或静脉（IV）镇静下于操作室/手术室进行。然而，这些操作中麻醉类型的适应证尚未确定。本综述的目的是评估使用不同麻醉类型进行食管扩张的结果，以评估基于诊室的技术的安全性。
我们进行了一项系统评价和荟萃分析，比较了成人 ED 麻醉技术的结果。排除标准包括综述、小病例系列、支架使用、高发病率诊断和罕见疾病。对 PubMed、CINAHL 和 EMBASE 数据库进行了全面的文献检索，以获取与食管扩张相关的文章。
共确定了 876 篇论文，其中 164 篇全文研究进行了评估，根据 PRISMA 指南，有 25 篇被纳入分析。提取了人口统计学、扩张技术和不良事件的数据。使用逆方差加权的 DerSimonian-Laird 随机效应模型拟合估计合并效应。根据麻醉情况，死亡率、穿孔或出血之间没有统计学上的显著差异。
随着基于诊室的程序在耳鼻喉科中的普及，需要对其安全性进行评估。基于诊室的 ED 似乎与全麻和 IV 镇静具有相当的安全性，尽管需要进一步研究来确定支持基于诊室技术的适应证。
