Gong Eun Jeong, Park Chan Hyuk, Jung Da Hyun, Kang Sun Hyung, Lee Ju Yup, Lim Hyun, Kim Do Hoon
Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24253, Korea.
Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Korea.
J Pers Med. 2022 Apr 12;12(4):621. doi: 10.3390/jpm12040621.
Although various endoscopic and surgical procedures are available for the treatment of gastroesophageal reflux disease (GERD), the comparative efficacy of these treatments has not been fully elucidated. This study aimed to comprehensively evaluate the efficacy of various endoscopic and surgical treatments for GERD. All relevant randomized controlled trials published through August 2021 that compared the efficacy of endoscopic and surgical GERD treatments, including radiofrequency energy delivery, endoscopic plication, reinforcement of the lower esophageal sphincter (LES), and surgical fundoplication, were searched. A network meta-analysis was performed to analyze treatment outcomes, including the requirement of proton pump inhibitor (PPI) continuation and GERD-health-related quality of life questionnaire score (GERD-HRQL). As such, 25 studies with 2854 patients were included in the analysis. Endoscopic plication, reinforcement of the LES, and surgical fundoplication were effective in reducing the requirement of PPI continuation compared to PPI therapy (pooled risk ratio (RR) (95% confidence interval [CI]): endoscopic plication, 0.34 (0.21-0.56); reinforcement of LES, 0.32 (0.16-0.63), and surgical fundoplication, 0.16 (0.06-0.42)). Radiofrequency energy delivery tended to reduce the requirement of PPI continuation compared to PPI therapy (RR (95% CI): 0.55 (0.25-1.18)). In terms of GERD-HRQL, all endoscopic and surgical treatments were superior to PPI therapy. In conclusion, all endoscopic or surgical treatments, except radiofrequency energy delivery, were effective for discontinuation of PPI medication, especially surgical fundoplication. Quality of life, measured by GERD-HRQL, also improved in patients who underwent endoscopic or surgical treatment compared to those who received PPI therapy.
尽管有多种内镜和外科手术可用于治疗胃食管反流病（GERD），但这些治疗方法的相对疗效尚未完全阐明。本研究旨在全面评估各种内镜和外科治疗GERD的疗效。检索了截至2021年8月发表的所有相关随机对照试验，这些试验比较了内镜和外科GERD治疗的疗效，包括射频能量传递、内镜折叠术、食管下括约肌（LES）强化术和外科胃底折叠术。进行网络荟萃分析以分析治疗结果，包括质子泵抑制剂（PPI）持续使用的需求和GERD健康相关生活质量问卷评分（GERD-HRQL）。分析共纳入25项研究，涉及2854例患者。与PPI治疗相比，内镜折叠术、LES强化术和外科胃底折叠术在降低PPI持续使用需求方面有效（合并风险比（RR）（95%置信区间[CI]）：内镜折叠术，0.34（0.21-0.56）；LES强化术，0.32（0.16-0.63），外科胃底折叠术，0.16（0.06-0.42））。与PPI治疗相比，射频能量传递倾向于降低PPI持续使用需求（RR（95%CI）：0.55（0.25-1.18））。在GERD-HRQL方面，所有内镜和外科治疗均优于PPI治疗。总之，除射频能量传递外，所有内镜或外科治疗在停用PPI药物方面均有效，尤其是外科胃底折叠术。与接受PPI治疗的患者相比，接受内镜或外科治疗的患者的生活质量（以GERD-HRQL衡量）也有所改善。
