内镜贲门周围组织瘢痕形成术（ECSF）治疗难治性胃食管反流病的疗效和安全性：系统评价与荟萃分析。
Efficacy and safety of endoscopic cardia peripheral tissue scar formation (ECSF) for the treatment of refractory gastroesophageal reflux disease: A systematic review with meta-analysis.
机构信息
The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Center for General Practice Medicine, Department of Gastroenterology, Zhejiang Provincial People's Hospital, (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
出版信息
Medicine (Baltimore). 2024 Mar 8;103(10):e37062. doi: 10.1097/MD.0000000000037062.
BACKGROUND
Endoscopic treatment is increasingly used for refractory gastroesophageal reflux disease (rGERD). Unlike the mechanism of conventional surgical fundoplication, gastroesophageal junction ligation, anti-reflux mucosal intervention, and radiofrequency ablation have extremely similar anti-reflux mechanisms; hence, we collectively refer to them as endoscopic cardia peripheral tissue scar formation (ECSF). We conducted a systematic review and meta-analysis to assess the safety and efficacy of ECSF in treating rGERD.
METHODS
We performed a comprehensive search of several databases, including PubMed, Embase, Medline, China Knowledge Network, and Wanfang, to ensure a systematic approach for data collection between January 2011 and July 2023. Forest plots were used to summarize and combine the GERD-health-related quality of life (HRQL), gastroesophageal reflux questionnaire score, and DeMeester scores, acid exposure time, lower esophageal sphincter pressure, esophagitis, proton pump inhibitors use, and patient satisfaction.
RESULTS
This study comprised 37 studies, including 1732 patients. After ECSF, significant improvement in gastroesophageal reflux disease health-related quality of life score (mean difference [MD] = 18.27 95% CI: 14.81-21.74), gastroesophageal reflux questionnaire score (MD = 4.85 95% CI: 3.96-5.75), DeMeester score (MD = 42.34, 95% CI: 31.37-53.30), acid exposure time (MD = 7.98, 95% CI: 6.03-9.92), and lower esophageal sphincter pressure was observed (MD = -5.01, 95% CI: -8.39 to 1.62). The incidence of serious adverse effects after ECSF was 1.1% (95% CI: 0.9%-1.2%), and postoperatively, 67.4% (95% CI: 66.4%-68.2%) of patients could discontinue proton pump inhibitor-like drugs, and the treatment outcome was observed to be satisfactory in over 80% of the patients. Subgroup analyses of the various procedures showed that all 3 types improved several objective or subjective patient indicators.
CONCLUSIONS
Based on the current meta-analysis, we conclude that rGERD can be safely and effectively treated with ECSF as an endoscopic procedure.
背景
内镜治疗越来越多地用于难治性胃食管反流病（rGERD）。与传统手术胃底折叠术的机制不同，胃食管交界处结扎、抗反流黏膜干预和射频消融具有极其相似的抗反流机制；因此，我们将它们统称为内镜贲门周围组织瘢痕形成（ECSF）。我们进行了系统评价和荟萃分析，以评估 ECSF 治疗 rGERD 的安全性和有效性。
方法
我们全面检索了多个数据库，包括 PubMed、Embase、Medline、中国知网和万方，以确保数据收集采用系统方法，时间范围为 2011 年 1 月至 2023 年 7 月。采用森林图汇总和合并 GERD 健康相关生活质量（HRQL）、胃食管反流问卷评分和 DeMeester 评分、酸暴露时间、食管下括约肌压力、食管炎、质子泵抑制剂使用和患者满意度。
结果
本研究共纳入 37 项研究，共 1732 例患者。ECSF 后，胃食管反流病健康相关生活质量评分（均数差 [MD] = 18.27，95%置信区间：14.81-21.74）、胃食管反流问卷评分（MD = 4.85，95%置信区间：3.96-5.75）、DeMeester 评分（MD = 42.34，95%置信区间：31.37-53.30）、酸暴露时间（MD = 7.98，95%置信区间：6.03-9.92）和食管下括约肌压力（MD =-5.01，95%置信区间：-8.39 至 1.62）均显著改善。ECSF 后严重不良事件的发生率为 1.1%（95%置信区间：0.9%-1.2%），术后 67.4%（95%置信区间：66.4%-68.2%）的患者可以停止质子泵抑制剂样药物，超过 80%的患者认为治疗效果满意。对各种手术的亚组分析表明，所有 3 种手术均能改善多项客观或主观的患者指标。
结论
根据目前的荟萃分析，我们得出结论，rGERD 可以通过内镜治疗安全有效地进行 ECSF 治疗。
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