Mohan Babu P, Bapaye Jay, Hamaad Rahman Syed, Loganathan Priyadarshini, Muthusamy Arunkumar, Ramai Daryl, Ponnada Suresh, Chandan Saurabh, Fang John
Gastroenterology and Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT (Babu P. Mohan, Daryl Ramai, John Fang).
Internal Medicine, Rochester General Hospital, NY (Jay Bapaye).
Ann Gastroenterol. 2022 Nov-Dec;35(6):584-591. doi: 10.20524/aog.2022.0749. Epub 2022 Oct 17.
Esophageal food bolus and/or foreign body (FB) impaction is a common gastrointestinal emergency. This meta-analysis reports on the pooled outcomes of cap-assisted endoscopic removal of esophageal FB.
We conducted a comprehensive search of several databases (inception to February 2022) to identify studies reporting on the use of a cap in the endoscopic treatment of esophageal FB ingestion. A random effects model was used to calculate the pooled odds ratio (OR) and mean difference (MD), and I values were used to assess the heterogeneity.
Six studies were analyzed that included 677 patients treated with cap-assisted and 694 with conventional endoscopy. The cap-assisted method demonstrated statistically significant superiority regarding technical success (pooled OR 7.1, 95% confidence interval [CI] 1.9-26.9; P=0.004), en bloc removal (pooled OR 26.6, 95%CI 17.6-40.2; P<0.001), as well as a significantly shorter procedure time (4.6 min, 95%CI -6.5 to -2.8; P<0.001), compared to conventional methods. Better technical success was achieved with the cap-assisted method performed under anesthesia (OR 8.7, 95%CI 1.6-47.7; P=0.01); however, a shorter procedure time was noted for the cap-assisted method without anesthesia (MD -1.5, 95%CI -2.7 to -0.4; P=0.01). Pooled adverse events were comparable. Pooled OR for mucosal tear was significantly lower with cap in food bolus impaction (OR 0.07, 95%CI 0.01-0.38; P=0.02).
Cap-assisted endoscopic removal of esophageal FB is associated with better technical success and en bloc removal, and a shorter procedure time compared to conventional methods, with comparable adverse events.
食管食物团块和/或异物嵌顿是常见的胃肠道急症。本荟萃分析报告了帽辅助内镜下取出食管异物的综合结果。
我们全面检索了多个数据库（从建库至2022年2月），以识别有关在内镜治疗食管异物摄入中使用帽的研究。采用随机效应模型计算合并比值比（OR）和平均差（MD），并使用I²值评估异质性。
分析了6项研究，其中677例患者接受帽辅助治疗，694例接受传统内镜检查。与传统方法相比，帽辅助方法在技术成功率（合并OR 7.1，95%置信区间[CI] 1.9 - 26.9；P = 0.004）、整块取出率（合并OR 26.6，95%CI 17.6 - 40.2；P < 0.001）以及手术时间显著缩短（4.6分钟，95%CI - 6.5至 - 2.8；P < 0.001）方面显示出统计学上的显著优势。在麻醉下进行帽辅助方法可获得更好的技术成功率（OR 8.7，95%CI 1.6 - 47.7；P = 0.01）；然而，未麻醉的帽辅助方法手术时间更短（MD - 1.5，95%CI - 2.7至 - 0.4；P = 0.01）。合并不良事件相当。食物团块嵌顿中使用帽时黏膜撕裂的合并OR显著更低（OR 0.07，95%CI 0.01 - 0.38；P = 0.02）。
与传统方法相比，帽辅助内镜下取出食管异物具有更好的技术成功率和整块取出率，手术时间更短，不良事件相当。
