黏膜切开辅助活检与内镜超声辅助组织获取用于上皮下病变：一项系统评价和荟萃分析

Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis.

作者信息

Giri Suprabhat, Afzalpurkar Shivaraj, Angadi Sumaswi, Sundaram Sridhar

机构信息

Nizam's Institute of Medical Sciences, Hyderabad, India.

Institute of Gastrosciences and Liver, Apollo Multispecialty Hospital, Kolkata, India.

出版信息

Clin Endosc. 2022 Sep;55(5):615-625. doi: 10.5946/ce.2022.133. Epub 2022 Aug 4.

BACKGROUND/AIMS: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis.

METHODS

A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs.

RESULTS

Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89-1.04) and procedural time (mean difference=-4.53 seconds; 95% CI, -22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71-0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83-1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63-0.89). Six studies reported no adverse events.

CONCLUSION

MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.

背景/目的：黏膜切开辅助活检（MIAB）用于获取上皮下病变（SELs）组织，正逐渐成为内镜超声（EUS）引导下获取组织的替代方法。仅有少数研究比较了MIAB和EUS对上消化道（GI）SELs的诊断效用；因此，我们进行了这项系统评价和荟萃分析。

方法

进行了一项从2020年1月至2022年1月的全面文献检索，以比较MIAB和EUS引导下对上消化道SELs获取组织的诊断准确性和安全性。

结果

本荟萃分析纳入了7项研究。两组之间的汇总技术成功率（风险比[RR]，0.96；95%置信区间[CI]，0.89 - 1.04）和操作时间（平均差值 = -4.53秒；95%CI，-22.38至13.31）相当。对于所有病变，EUS获得阳性诊断结果的总体几率低于MIAB（RR，0.83；95%CI，0.71 - 0.98），但使用细针活检针时两者相当（RR，0.93；95%CI，0.83 - 1.04）。对于<20 mm的病变，MIAB的阳性诊断率更高（RR，0.75；95%CI，0.63 - 0.89）。6项研究报告无不良事件。