Gong Fangxiao, Li Yuanyuan, Ye Sen
Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China.
Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
Asian J Surg. 2023 Jan;46(1):24-34. doi: 10.1016/j.asjsur.2022.03.116. Epub 2022 Apr 26.
Achalasia(AC) is an esophageal motility disorder characterized by decreased esophageal motility and impaired relaxation of lower esophageal sphincter(LES). The treatment of achalasia is continuously improved for the development of technology, but each treatment has its own advantages and disadvantages. This article was to compare the efficacy and complication of different treatment on AC. PUBMED/MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched for eligible studies. A random-effects model within a Bayesian framework was applied to compare treatment effects as odds ratio (OR) with their corresponding 95% credible interval (CI), also OR was applied to compare complication with 95% CI. The surface under the cumulative ranking area (SUCRA) was calculated to make the ranking of the treatments for outcomes. Twenty-seven randomized controlled trials (RCTs) were eligible. According to SUCRA ranking, anterior peroral endoscopic myotomy (APOEM) (SUCRA = 84.6%) might have the highest probability to be the best treatment for dysphagia remission in AC patients, followed by POEM (SUCRA = 78.4%). For gastroesophageal reflux disease (GERD) assessment, the corresponding SUCRA values indicated that botulinum toxin(BT) (SUCRA = 18.3%) might have lowest GERD incidence rate and POEM ranked the worst (SUCRA = 69.8%).. APOEM might have the highest probability to be the best therapeutic strategy for dysphagia remission in a short-term of follow-up, but the GERD incidence rate was high. BT injection might have the lowest probability to treat dysphagia, but the risk of GERD was the lowest. In the future, more RCTs with higher qualities are needed to make head-to-head comparison between 2 or more treatments.
贲门失弛缓症（AC）是一种食管动力障碍性疾病，其特征为食管动力降低和食管下括约肌（LES）松弛受损。随着技术的发展，贲门失弛缓症的治疗方法不断改进，但每种治疗方法都有其优缺点。本文旨在比较不同治疗方法对AC的疗效和并发症。检索了PUBMED/MEDLINE、EMBASE和Cochrane对照试验中央注册库以查找符合条件的研究。采用贝叶斯框架下的随机效应模型，以比值比（OR）及其相应的95%可信区间（CI）比较治疗效果，同时用OR及其95%CI比较并发症。计算累积排序曲线下面积（SUCRA）以对各治疗方法的疗效进行排序。27项随机对照试验（RCT）符合条件。根据SUCRA排序，经口内镜下前路肌切开术（APOEM）（SUCRA = 84.6%）可能是AC患者吞咽困难缓解的最佳治疗方法的可能性最高，其次是经口内镜下肌切开术（POEM）（SUCRA = 78.4%）。对于胃食管反流病（GERD）评估，相应的SUCRA值表明肉毒杆菌毒素（BT）（SUCRA = 18.3%）可能GERD发病率最低，而POEM排名最差（SUCRA = 69.8%）。APOEM在短期随访中可能是吞咽困难缓解的最佳治疗策略的可能性最高，但GERD发病率较高。BT注射治疗吞咽困难的可能性最低，但GERD风险最低。未来，需要更多高质量的RCT来对两种或更多治疗方法进行直接比较。
