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多波段黏膜切除术治疗巴雷特食管的安全性和有效性:一项汇总分析的系统评价

Safety and efficacy of multiband mucosectomy for Barrett's esophagus: a systematic review with pooled analysis.

作者信息

Spadaccini Marco, Belletrutti Paul J, Attardo Simona, Maselli Roberta, Chandrasekar Viveksandeep Thoguluva, Galtieri Piera Alessia, Fugazza Alessandro, Anderloni Andrea, Carrara Silvia, Pellegatta Gaia, Hassan Cesare, Sharma Prateek, Repici Alessandro

机构信息

Endoscopy Unit "Humanitas Research Hospital", MI, Italy (Marco Spadaccini, Roberta Maselli, Piera Alessia Galtieri, Alessandro Fugazza, Andrea Anderloni, Silvia Carrara, Gaia Pellegatta, Alessandro Repici).

Department of Biomedical Sciences, Humanitas University, MI, Italy (Marco Spadaccini, Alessandro Repici).

出版信息

Ann Gastroenterol. 2021 Jul-Aug;34(4):487-492. doi: 10.20524/aog.2021.0620. Epub 2021 Apr 2.


DOI:10.20524/aog.2021.0620
PMID:34276186
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8276358/
Abstract

BACKGROUND: According to guidelines, all visible lesions in Barrett's esophagus (BE) should be endoscopically resected. Available methods of endoscopic resection include the cap-assisted technique and, more recently, multiband mucosectomy (MBM). Data on the efficacy and safety of MBM have yet to be systematically reviewed. We performed the first systematic review with pooled analysis to evaluate the outcomes of MBM in patients with BE. METHODS: Electronic databases (Medline, Scopus, EMBASE) were searched up to August 2019. Studies including patients with BE who underwent MBM were eligible. The primary outcome was the adverse events rate. Secondary outcomes were the proportions of complete resections and R0 resections. Outcomes were assessed by pooling data using a random or fixed-effect model, according to the degree of heterogeneity, to obtain a proportion with a 95% confidence interval. RESULTS: Fourteen studies were eligible (1334 procedures, 986 patients). The adverse event rate was 5.3%. Immediate and post-procedural bleeding, perforations and strictures occurred in 0.2%, 0.7%, 0.3% and 3.9% of procedures, respectively. Focal lesions were resected at a complete rate of 97.6% with an R0 resection rate of 94.1%. CONCLUSION: MBM is a safe and effective technique for treating visible lesions in BE.

摘要

背景:根据指南,巴雷特食管(BE)中的所有可见病变均应在内镜下切除。现有的内镜切除方法包括套扎辅助技术,以及最近出现的多环套扎黏膜切除术(MBM)。关于MBM疗效和安全性的数据尚未得到系统评价。我们进行了首次系统评价并进行汇总分析,以评估MBM治疗BE患者的疗效。 方法:检索截至2019年8月的电子数据库(Medline、Scopus、EMBASE)。纳入对接受MBM治疗的BE患者的研究。主要结局为不良事件发生率。次要结局为完全切除率和R0切除率。根据异质性程度,采用随机或固定效应模型汇总数据来评估结局,以获得95%置信区间的比例。 结果:14项研究符合要求(1334例手术,986例患者)。不良事件发生率为5.3%。手术中及术后即刻出血、穿孔和狭窄的发生率分别为0.2%、0.7%、0.3%和3.9%。局灶性病变的完全切除率为97.6%,R0切除率为94.1%。 结论:MBM是治疗BE可见病变的一种安全有效的技术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ab6/8276358/d4488a14fab2/AnnGastroenterol-34-487-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ab6/8276358/52de5faf7202/AnnGastroenterol-34-487-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ab6/8276358/0c0f0a5d389c/AnnGastroenterol-34-487-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ab6/8276358/d4488a14fab2/AnnGastroenterol-34-487-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ab6/8276358/52de5faf7202/AnnGastroenterol-34-487-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ab6/8276358/0c0f0a5d389c/AnnGastroenterol-34-487-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ab6/8276358/d4488a14fab2/AnnGastroenterol-34-487-g003.jpg

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引用本文的文献

[1]
Advanced imaging and artificial intelligence for Barrett's esophagus: What we should and soon will do.

World J Gastroenterol. 2022-3-21

本文引用的文献

[1]
Multi-band mucosectomy for neoplasia in patients with Barrett's esophagus: in vivo comparison between two different devices.

Surg Endosc. 2020-9

[2]
Comparison of two multiband mucosectomy devices for endoscopic resection of Barrett's esophagus-related neoplasia.

Surg Endosc. 2019-1-22

[3]
A prospective multicenter study using a new multiband mucosectomy device for endoscopic resection of early neoplasia in Barrett's esophagus.

Gastrointest Endosc. 2018-7-6

[4]
Endoscopic submucosal dissection for early Barrett's neoplasia: a meta-analysis.

Gastrointest Endosc. 2017-10-6

[5]
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Endoscopy. 2017-1-25

[6]
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Endosc Int Open. 2016-12

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Gut. 2015-3-2

[8]
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BMJ. 2015-1-2

[9]
Trends in esophageal adenocarcinoma incidence and mortality.

Cancer. 2012-12-11

[10]
Focal endoscopic mucosal resection before radiofrequency ablation is equally effective and safe compared with radiofrequency ablation alone for the eradication of Barrett's esophagus with advanced neoplasia.

Gastrointest Endosc. 2012-6-23

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