Department of Gastroenterology, Sanmen County People's Hospital, Taizhou, Zhejiang, China.
Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
PLoS One. 2024 May 6;19(5):e0302204. doi: 10.1371/journal.pone.0302204. eCollection 2024.
Barrett's esophagus (BE) is a precancerous condition that has the potential to develop into esophageal cancer (EC). Currently, there is a wide range of management options available for individuals at different pathological stages in Barrett's esophagus (BE). However, there is currently a lack of knowledge regarding their comparative efficacy. To address this gap, we conducted a network meta-analysis of published randomized controlled trials to examine the comparative effectiveness of all regimens.
Data extracted from eligible randomized controlled trials were utilized in a Bayesian network meta-analysis to examine the relative effectiveness of BE's treatment regimens and determine their ranking in terms of efficacy. The ranking probability for each regimen was assessed using the surfaces under cumulative ranking values. The outcomes under investigation were complete ablation of BE, neoplastic progression of BE, and complete eradication of dysplasia.
We identified twenty-three RCT studies with a total of 1675 participants, and ten different interventions. Regarding complete ablation of non-dysplastic BE, the comparative effectiveness ranking indicated that argon plasma coagulation (APC) was the most effective regimen, with the highest SUCRA value, while surveillance and PPI/H2RA were found to be the least efficacious regimens. For complete ablation of BE with low-grade dysplasia, high-grade dysplasia, or esophageal cancer, photodynamic therapy (PDT) had the highest SUCRA value of 94.1%, indicating it as the best regimen. Additionally, for complete eradication of dysplasia, SUCRA plots showed a trend in ranking PDT as the highest with a SUCRA value of 91.2%. Finally, for neoplastic progression, radiofrequency ablation (RFA) and surgery were found to perform significantly better than surveillance. The risk of bias assessment revealed that 6 studies had an overall high risk of bias. However, meta-regression with risk of bias as a covariate did not indicate any influence on the model. In terms of the Confidence in Network Meta-Analysis evaluation, a high level of confidence was found for all treatment comparisons.
Endoscopic surveillance alone or PPI/H2RA alone may not be sufficient for managing BE, even in cases of non-dysplastic BE. However, APC has shown excellent efficacy in treating non-dysplastic BE. For cases of BE with low-grade dysplasia, high-grade dysplasia, or esophageal cancer, PDT may be the optimal intervention as it can induce regression of BE metaplasia and prevent future progression of BE to dysplasia and EC.
巴雷特食管（BE）是一种癌前病变，有发展为食管癌（EC）的潜力。目前，对于处于不同病理阶段的 BE 患者，有广泛的管理选择。然而，目前对于这些治疗方案的比较疗效还缺乏了解。为了弥补这一空白，我们对已发表的随机对照试验进行了网络荟萃分析，以检查所有方案的比较疗效。
从符合条件的随机对照试验中提取的数据用于贝叶斯网络荟萃分析，以检查 BE 治疗方案的相对疗效，并确定它们在疗效方面的排名。使用累积排序值下的曲面来评估每种方案的排名概率。研究的结果是 BE 的完全消融、BE 的肿瘤进展和异型增生的完全消除。
我们确定了 23 项 RCT 研究，共涉及 1675 名参与者和 10 种不同的干预措施。关于非异型增生 BE 的完全消融，比较疗效排名表明氩等离子凝固（APC）是最有效的方案，SUCRA 值最高，而监测和 PPI/H2RA 是最无效的方案。对于低级别异型增生、高级别异型增生或食管癌的 BE 完全消融，光动力疗法（PDT）的 SUCRA 值最高为 94.1%，表明其为最佳方案。此外，对于异型增生的完全消除，SUCRA 图显示 PDT 的排名趋势最高，SUCRA 值为 91.2%。最后，对于肿瘤进展，射频消融（RFA）和手术明显优于监测。偏倚风险评估显示，有 6 项研究的总体偏倚风险较高。然而，将偏倚风险作为协变量进行元回归并没有表明对模型有任何影响。在网络荟萃分析评估的置信度方面，所有治疗比较的置信度都很高。
单独进行内镜监测或单独使用 PPI/H2RA 可能不足以管理 BE，即使是非异型增生的 BE 也是如此。然而，APC 在治疗非异型增生 BE 方面显示出了极好的疗效。对于低级别异型增生、高级别异型增生或食管癌的 BE，PDT 可能是最佳干预措施，因为它可以诱导 BE 化生的消退，并防止 BE 向异型增生和 EC 的进一步进展。
