Garg Rajat, Mohammed Abdul, Singh Amandeep, Schleicher Mary, Thota Prashanthi N, Rustagi Tarun, Sanaka Madhusudhan R
Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic, Cleveland, Ohio, United States.
Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, United States.
Endosc Int Open. 2022 Jun 10;10(6):E854-E864. doi: 10.1055/a-1802-0220. eCollection 2022 Jun.
Anti-reflux mucosectomy (ARMS) is an emerging endoscopic treatment for refractory gastroesophageal reflux disease (GERD). We conducted a systematic review and meta-analysis to evaluate the safety and efficacy ARMS in refractory GERD. A comprehensive search of multiple databases (through March 2020) was performed to identify studies that reported outcomes of ARMS for refractory GERD. Outcomes assessed included technical success, clinical response, and adverse events (AEs). Clinical response was defined as discontinuation (complete) or reduction (partial) of proton pump inhibitors post-ARMS at follow up. A total of 307 patients (mean age 46.9 [8.1] years, 41.5 % females) were included from 10 studies. The technical success and clinical response rates were 97.7 % (95 % confidence interval [CI], 94.6-99.0) and 80.1 % (95 % CI, 61.6-91.0), respectively. The pooled rate of complete and partial clinical response was 65.3 % (95 % CI, 51.4-77.0) and 21.5 % (95 % CI, 14.2-31.2), respectively. The rate of AEs was 17.2 % (95 % CI, 13.1-22.2) with most common AE being dysphagia/esophageal stricture followed by bleeding with rates of 11.4 % and 5.0 %, respectively. GERD health-related quality of life (GERD-HRQL) (mean difference [MD] = 14.9, < 0.001), GERD questionnaire (GERD-Q) (MD = 4.85, < 0.001) and mean acid exposure time (MD = 2.39, = 0.01) decreased significantly post-ARMS as compared to pre-procedure. There was no difference in terms of clinical response and AEs between ARMS and ARMS with banding on subgroup analysis. ARMS is a safe and effective procedure for treatment of refractory GERD with high rates of clinical response, acceptable safety profile and significant improvement in GERD-related quality of life. Prospective studies are needed to validate our findings.
抗反流黏膜切除术（ARMS）是一种新兴的用于治疗难治性胃食管反流病（GERD）的内镜治疗方法。我们进行了一项系统评价和荟萃分析，以评估ARMS治疗难治性GERD的安全性和有效性。对多个数据库进行了全面检索（截至2020年3月），以确定报告ARMS治疗难治性GERD结果的研究。评估的结果包括技术成功率、临床反应和不良事件（AE）。临床反应定义为随访时ARMS术后质子泵抑制剂停药（完全）或减量（部分）。10项研究共纳入307例患者（平均年龄46.9[8.1]岁，41.5%为女性）。技术成功率和临床反应率分别为97.7%（95%置信区间[CI]，94.6 - 99.0）和80.1%（95%CI，61.6 - 91.0）。完全和部分临床反应的合并率分别为65.3%（95%CI，51.4 - 77.0）和21.5%（95%CI，14.2 - 31.2）。AE发生率为17.2%（95%CI，13.1 - 22.2），最常见的AE是吞咽困难/食管狭窄，其次是出血，发生率分别为11.4%和5.0%。与术前相比，ARMS术后GERD健康相关生活质量（GERD - HRQL）（平均差值[MD]=14.9，<0.001）、GERD问卷（GERD - Q）（MD = 4.85，<0.001）和平均酸暴露时间（MD = 2.39，= 0.01）显著降低。亚组分析显示，ARMS与带环ARMS在临床反应和AE方面无差异。ARMS是一种治疗难治性GERD的安全有效的方法，临床反应率高，安全性可接受，且GERD相关生活质量有显著改善。需要进行前瞻性研究来验证我们的发现。
