与传统内镜黏膜下剥离术相比，使用橡皮筋和夹子的内镜黏膜下剥离术：一项系统评价和荟萃分析。
Endoscopic Submucosal Dissection with Rubber Bands and Clips Compared to Conventional Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis.
作者信息
Awad Abdelaziz A, Abosheaishaa Hazem, Hassan Malak A, Marey Mohamed Mahmoud, Bahnasy Ahmed, Mohamed Rashad G, Keshk Menna A, Alnomani Yousef Radwan, Balouz Manar A, Hussein Ahmed Abdelgayed M, Mohamed Fatma S, Alaeb Mohammed A, Sharaf Mohamed S, Ahmed Omar T, Neknam Nigar, Andrawes Sherif
机构信息
Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
出版信息
Dig Dis Sci. 2025 May 3. doi: 10.1007/s10620-025-09074-z.
The rising number of gastrointestinal (GI) tumors, including esophageal, gastric, and colorectal tumors, makes it essential to develop more effective treatment methods. Endoscopic submucosal dissection (ESD) has become a popular intervention due to its ability to resect the tumor completely and prevent local recurrence. This study evaluates the safety and efficacy of ESD with rubber bands and clips (ESD-RBC) in the treatment of various GI tumors. We systematically searched Embase, Scopus, Web of Science, Medline/PubMed, and Cochrane databases until April 20, 2024. Eligible studies included clinical trials and observational studies focusing on ESD-RBC alone or compared to conventional ESD (C-ESD) in patients with gastrointestinal tumors. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) tool. Statistical analyses were performed using RevMan and R software. ESD-RBC was superior to C-ESD in achieving R0 resection and en bloc resection (OR: 1.99 with 95% CI [1.17 to 3.36], P = 0.01, I = 0%) and (OR: 5.98 with 95% CI [2.30 to 15.55]; P = 0.0002, I = 0%), respectively. ESD-RBC enhanced the resection speed compared to C-ESD (MD: 8.48 mm/min with 95% CI [3.12 to 13.83]; P < 0.00001, I = 89%) and shortened the procedure duration (MD: - 11.94 min with 95% CI [- 21.98 to - 1.91]; P < 0.00001, I = 7%). There was no statistically significant difference between both groups in terms of bleeding and delayed bleeding (OR: 1.08 with 95% CI [0.37 to 3.14]; P = 0.89, I = 0%) and (OR: 0.69 with 95% CI [0.20 to 2.33]; P = 0.55, I = 0%), respectively. The proportion of R0 resection using ESD-RBC was 90%, with 95% CI [65% to 98%] and I = 78%. The en bloc resection rate was 96%, with 95% CI [95% to 97%], and I = 0%. In addition, the raw mean (MRAW) of resection speed was 24.25 mm2/min, with 95% CI [13.48 to 35.02], and I = 99.4%. ESD-RBC was superior to C-ESD in achieving en bloc resection and R0 resection with a comparable risk of bleeding and delayed bleeding. In addition, ESD-RBC enhanced the resection speed and shortened the procedure duration.
包括食管癌、胃癌和结直肠癌在内的胃肠道（GI）肿瘤数量不断增加，因此开发更有效的治疗方法至关重要。内镜黏膜下剥离术（ESD）因其能够完全切除肿瘤并预防局部复发，已成为一种常用的干预手段。本研究评估了采用橡皮筋和夹子的ESD（ESD-RBC）治疗各种胃肠道肿瘤的安全性和有效性。我们系统检索了截至2024年4月20日的Embase、Scopus、Web of Science、Medline/PubMed和Cochrane数据库。符合条件的研究包括专注于ESD-RBC的临床试验和观察性研究，或与胃肠道肿瘤患者的传统ESD（C-ESD）进行比较的研究。使用纽卡斯尔-渥太华量表（NOS）工具评估偏倚风险。使用RevMan和R软件进行统计分析。ESD-RBC在实现R0切除和整块切除方面优于C-ESD，分别为（比值比：1.99，95%置信区间[1.17至3.36]，P = 0.01，I = 0%）和（比值比：5.98，95%置信区间[2.30至15.55]；P = 0.0002，I = 0%）。与C-ESD相比，ESD-RBC提高了切除速度（平均差：8.48毫米/分钟，95%置信区间[3.12至13.83]；P < 0.00001，I = 89%）并缩短了手术时间（平均差：-11.94分钟，95%置信区间[-21.98至-1.91]；P < 0.00001，I = 7%）。两组在出血和延迟出血方面无统计学显著差异，分别为（比值比：1.08，95%置信区间[0.37至3.14]；P = 0.89，I = 0%）和（比值比：0.69，95%置信区间[0.20至2.33]；P = 0.55，I = 0%）。使用ESD-RBC的R0切除比例为90%，95%置信区间[65%至98%]，I = 78%。整块切除率为96%，95%置信区间[95%至97%]，I = 0%。此外，切除速度的原始均值（MRAW）为24.25平方毫米/分钟，95%置信区间[13.48至35.02]，I = 99.4%。ESD-RBC在实现整块切除和R0切除方面优于C-ESD，且出血和延迟出血风险相当。此外，ESD-RBC提高了切除速度并缩短了手术时间。
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