Department of Surgery, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada.
Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada.
Surg Endosc. 2023 Aug;37(8):5791-5806. doi: 10.1007/s00464-023-10202-x. Epub 2023 Jul 5.
INTRODUCTION: Endoscopic plication offers an alternative to surgical fundoplication for treatment of gastroesophageal reflux disease (GERD). This systematic review and meta-analysis evaluate outcomes following endoscopic plication compared to laparoscopic fundoplication. METHODS AND PROCEDURES: Systematic search of MEDLINE, Embase, Scopus, and Web of Science was conducted in September 2022. Study followed PRISMA guidelines. Studies comparing endoscopic plication to laparoscopic fundoplication with n > 5 were included. Primary outcome was PPI cessation, with secondary outcomes including complications, procedure duration, length of stay, change in lower esophageal sphincter (LES) tone, and DeMeester score. RESULTS: We reviewed 1544 studies, with five included comparing 105 (46.1%) patients receiving endoscopic plication (ENDO) to 123 (53.9%) undergoing laparoscopic fundoplication (LAP). Average patient age was 47.6 years, with those undergoing plication being younger (46.4 ENDO vs 48.5 LAP). BMI (26.6 kg/m ENDO vs 26.2 kg/m LAP), and proportion of females (42.9% ENDO vs 37.4% LAP) were similar. Patients undergoing laparoscopic procedures had worse baseline LES pressure (12.8 mmHg ENDO vs 9.0 mmHg LAP) and lower preoperative DeMeester scores (34.6 ENDO vs. 34.1 LAP). The primary outcome demonstrated that 89.2% of patients undergoing laparoscopic fundoplication discontinued PPI compared to 69.4% for those receiving plication. Meta-analysis revealed that plication had significantly reduced odds of PPI discontinuation (OR 0.27, studies = 3, 95% CI 0.12 to 0.64, P = 0.003, I = 0%). Secondary outcomes demonstrated that odds of complications (OR 1.46, studies = 4, 95% CI 0.34 to 6.32, P = 0.62, I = 0%), length of stay (MD - 1.37, studies = 3, 95% CI - 3.48 to 0.73, P = 0.20, I = 94%), and procedure durations were similar (MD 0.78, studies = 3, 95% CI - 39.70 to 41.26, P = 0.97, I = 98%). CONCLUSIONS: This is the first meta-analysis comparing endoscopic plication to laparoscopic fundoplication. Results demonstrate greater likelihood of PPI discontinuation with laparoscopic fundoplication with similar post-procedural risk.
简介：内镜折叠术为治疗胃食管反流病（GERD）提供了一种替代手术胃底折叠术的方法。本系统评价和荟萃分析评估了内镜折叠术与腹腔镜胃底折叠术相比的结果。
方法和程序：系统检索了 2022 年 9 月的 MEDLINE、Embase、Scopus 和 Web of Science。研究遵循 PRISMA 指南。纳入了比较内镜折叠术与腹腔镜胃底折叠术的 n > 5 的研究。主要结局是 PPI 停药，次要结局包括并发症、手术持续时间、住院时间、下食管括约肌（LES）张力变化和德梅斯特评分。
结果：我们共回顾了 1544 项研究，其中 5 项研究比较了 105 例（46.1%）接受内镜折叠术（ENDO）的患者和 123 例（53.9%）接受腹腔镜胃底折叠术（LAP）的患者。平均患者年龄为 47.6 岁，接受折叠术的患者更年轻（46.4ENDO 比 48.5LAP）。BMI（26.6kg/m2ENDO 比 26.2kg/m2LAP）和女性比例（42.9%ENDO 比 37.4%LAP）相似。接受腹腔镜手术的患者 LES 压力较低（12.8mmHgENDO 比 9.0mmHgLAP），术前德梅斯特评分较低（34.6ENDO 比 34.1LAP）。主要结局显示，接受腹腔镜胃底折叠术的患者中有 89.2%停止使用 PPI，而接受折叠术的患者中有 69.4%停止使用 PPI。荟萃分析显示，折叠术显著降低了 PPI 停药的可能性（OR 0.27，研究数=3，95%CI 0.12 至 0.64，P=0.003，I=0%）。次要结局表明，并发症的可能性（OR 1.46，研究数=4，95%CI 0.34 至 6.32，P=0.62，I=0%）、住院时间（MD-1.37，研究数=3，95%CI-3.48 至 0.73，P=0.20，I=94%）和手术持续时间相似（MD0.78，研究数=3，95%CI-39.70 至 41.26，P=0.97，I=98%）。
结论：这是第一项比较内镜折叠术与腹腔镜胃底折叠术的荟萃分析。结果表明，腹腔镜胃底折叠术更有可能停止使用 PPI，但术后风险相似。
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