Shah Sagar N, Chehade Nabil El Hage, Tavangar Amirali, Choi Alyssa, Monachese Marc, Chang Kenneth J, Samarasena Jason B
Department of Internal Medicine, Los Angeles Medical Center, University of California, Los Angeles, CA, USA.
Division of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Clin Endosc. 2023 Jan;56(1):38-49. doi: 10.5946/ce.2022.179. Epub 2023 Jan 30.
BACKGROUND/AIMS: Patients with Barrett's esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC.
We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett's esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM.
Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872-0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005-0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007-0.055; I2=0%).
Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.
背景/目的：巴雷特食管患者发生食管腺癌的风险增加。内镜治疗旨在根除发育异常和化生组织。混合氩等离子体凝固术（hybrid-APC）在消融前利用黏膜下液体注射形成一个保护垫，以保护黏膜下层免受损伤。我们进行了一项汇总荟萃分析，以评估hybrid-APC的安全性和有效性。
我们于2022年4月对主要电子数据库进行了系统检索。纳入的研究对象为接受hybrid-APC治疗的发育异常和非发育异常的巴雷特食管患者。观察指标包括肠化生完全缓解（CR-IM）、狭窄形成、严重不良事件以及实现CR-IM所需的治疗次数。
接受hybrid-APC治疗的患者总体汇总CR-IM率为90.8%（95%置信区间[CI]，0.872-0.939；I2=0%）。汇总狭窄率为2.0%（95%CI，0.005-0.042；I2=0%）。总体严重不良事件率为2.7%（95%CI，0.007-0.055；I2=0%）。
当前荟萃分析的结果表明，hybrid-APC与高CR-IM率及良好的安全性相关。这些结果的解释受到回顾性队列研究和病例系列数据纳入的限制。需要进行标准化治疗和结果评估方案的随机对照试验，以了解这种治疗选择与当前护理标准的可比性。
