射频消融术与内镜监测对低度异型增生巴雷特食管的疗效及安全性：随机对照试验的荟萃分析
Efficacy and Safety of Radiofrequency Ablation vs. Endoscopic Surveillance for Barrett's Esophagus With Low-Grade Dysplasia: Meta-Analysis of Randomized Controlled Trials.
作者信息
Wang Yizi, Ma Bin, Yang Shize, Li Wenya, Li Peiwen
机构信息
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.
出版信息
Front Oncol. 2022 Feb 28;12:801940. doi: 10.3389/fonc.2022.801940. eCollection 2022.
BACKGROUND AND AIMS
Barrett's esophagus with low-grade dysplasia (BE-LGD) carries a risk of progression to Barrett's esophagus with high-grade dysplasia (BE-HGD) and esophageal adenocarcinoma (EAC). Radiofrequency ablation (RFA) appears to be a safe and efficacious method to eradicate Barrett's esophagus. However, a confirmed consensus regarding treatment of BE-LGD with RFA vs. endoscopic surveillance is lacking. Therefore, this study aimed to elucidate the efficacy and safety for RFA vs. endoscopic surveillance in decreasing the risk of BE-LGD progression to BE-HGD or EAC.
METHODS
Relevant studies published before May 1, 2021 were identified by searching relevant medical databases. The primary outcome was the rate of progression BE-LGD to HGD and/or EAC after treatment with RFA and endoscopic surveillance. The secondary outcome was the rate of complete eradication of dysplasia (CE-D) and complete eradication of intestinal metaplasia (CE-IM) after treatment with RFA and endoscopic surveillance. Adverse events were also extracted and evaluated.
RESULTS
Three randomized controlled trials were eligible for analysis. The pooled estimate of rate of neoplastic progression of BE-LGD to HGD or EAC was much lower in the RFA group than the endoscopic surveillance group (RR, 0.25; 95% CI, 0.07-0.93; P = 0.04), with moderate heterogeneity (I = 55%). Subgroup analysis based on progression grade was performed. The pooled rate of progression of BE-LGD to HGD was much lower in the RFA group than the endoscopic surveillance group (RR, 0.25; 95% CI, 0.07-0.71; P = 0.01), with low heterogeneity (I = 15%). Although the pooled risk of progression of BE-LGD to EAC was slightly lower in the RFA group than the endoscopic surveillance group (RR, 0.56; 95% CI, 0.05-6.76), the result was not statistically significant (P = 0.65). RFA also was associated a higher rate of CE-D and CE-IM both at the end of endoscopic treatment and during follow-up. However, the rate of adverse events was slightly higher after RFA treatment.
CONCLUSION
RFA decreases the risk of BE-LGD progression to BE-HGD. However, given the uncertain course of LGD and the potential for esophageal stricture after RFA, treatment options should be fully considered and weighed.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021266128, identifier PROSPERO (CRD42021266128).
背景与目的
伴有低度异型增生的巴雷特食管（BE-LGD）有进展为伴有高度异型增生的巴雷特食管（BE-HGD）和食管腺癌（EAC）的风险。射频消融（RFA）似乎是根除巴雷特食管的一种安全有效的方法。然而，对于采用RFA治疗BE-LGD与内镜监测，目前尚无确定的共识。因此，本研究旨在阐明RFA与内镜监测在降低BE-LGD进展为BE-HGD或EAC风险方面的疗效和安全性。
方法
通过检索相关医学数据库，确定2021年5月1日前发表的相关研究。主要结局是RFA治疗和内镜监测后BE-LGD进展为HGD和/或EAC的发生率。次要结局是RFA治疗和内镜监测后异型增生完全根除（CE-D）和肠化生完全根除（CE-IM）的发生率。还提取并评估了不良事件。
结果
三项随机对照试验符合分析条件。RFA组中BE-LGD进展为HGD或EAC的肿瘤进展率的合并估计值远低于内镜监测组（RR，0.25；95%CI，0.07-0.93；P = 0.04），具有中度异质性（I² = 55%）。进行了基于进展分级的亚组分析。RFA组中BE-LGD进展为HGD的合并发生率远低于内镜监测组（RR，0.25；95%CI，0.07-0.71；P = 0.01），具有低异质性（I² = 15%）。虽然RFA组中BE-LGD进展为EAC的合并风险略低于内镜监测组（RR，0.56；95%CI，0.05-6.76），但结果无统计学意义（P = 0.65）。RFA在内镜治疗结束时及随访期间也与更高的CE-D和CE-IM发生率相关。然而，RFA治疗后的不良事件发生率略高。
结论
RFA降低了BE-LGD进展为BE-HGD的风险。然而，鉴于LGD病程的不确定性以及RFA后食管狭窄的可能性，应充分考虑并权衡治疗方案。
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