内镜黏膜下剥离术与内镜黏膜切除术在早期巴雷特瘤治疗中的对比：系统回顾与荟萃分析。

IF 5 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy Pub Date : 2024-09-02 DOI:10.1111/den.14892

Megui Marilia Mansilla Gallegos, Igor Logetto Caetité Gomes, Vitor Ottoboni Brunaldi, Alexandre Moraes Bestetti, Sergio Barbosa Marques, Nelson Tomio Miyajima, Hiram Menezes Nascimento Filho, Pedro Henrique Veras Ayres da Silva, Angelo So Taa Kum, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura

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引用次数: 0

摘要

目的：内镜切除术是治疗早期巴雷特肿瘤的首选方法，可减少手术干预的需要。然而，内镜粘膜切除术（EMR）和内镜粘膜下剥离术（ESD）之间的最佳选择仍不明确。本研究旨在比较 EMR 与 ESD 对早期巴雷特肿瘤的疗效和安全性：方法：在 MEDLINE、Cochrane 中心、EMBASE 和 LILACS 中进行电子检索，检索期至 2023 年 11 月。方法：在MEDLINE、Central Corane、EMBASE和LILACS中进行电子检索，检索期至2023年11月，纳入了比较ESD与EMR治疗早期巴雷特瘤患者的研究。本研究根据《系统综述和荟萃分析首选报告项目》指南进行。ROBIN-I工具用于分析偏倚风险，GRADE工具用于衡量证据质量：结果：共纳入了 15 项观察性研究中的 9352 名患者。结果：共纳入15项观察性研究中的9352名患者，ESD患者的全切率明显更高（几率比[OR] 25.96，95%置信区间[CI] 13.82，48.74；I2 = 52%；P 2 = 73%；P 2 = 88%；P = 0.04）：结论：在治疗早期巴雷特瘤方面，内镜黏膜下剥离术比EMR更有效，但不良反应率较高。

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Endoscopic submucosal dissection vs. endoscopic mucosal resection in the treatment of early Barrett's neoplasia: Systematic review and meta-analysis

Objectives

Endoscopic resection is the preferred approach to treat early Barrett's neoplasia, reducing the need for surgical interventions. However, the best choice between endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) remains unclear. The study aimed to compare the efficacy and safety of EMR vs. ESD for early Barrett's neoplasia.

Methods

An electronic search was conducted in MEDLINE, Central Cochrane, EMBASE, and LILACS until November 2023. Studies comparing ESD vs. EMR in the treatment of patients with early Barrett's neoplasia were included. This study was performed according to the Preferred Report Items for Systematic Reviews and Meta-Analyses guidelines. The ROBIN-I tool was used to analyze the risk of bias and GRADE to measure the quality of the evidence.

Results

A total of 9352 patients from 15 observational studies were included. Patients undergoing ESD had significantly higher rates of en-bloc (odds ratio [OR] 25.96, 95% confidence interval [CI] 13.82, 48.74; I² = 52%; P < 0.00001) and R0 (OR 5.10, 95% CI 3.29, 7.91; I² = 73%; P < 0.00001) with a higher risk of adverse events, including bleeding, stricture formation, and perforation. In a subgroup analysis of patients who did not receive radiofrequency ablation, ESD had a lower recurrence rate than EMR (OR 0.22, 95% CI 0.05, 0.94; I² = 88%; P = 0.04).

Conclusion

Endoscopic submucosal dissection is more effective than EMR in treating early Barrett's neoplasia at the expense of higher adverse events rates.

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来源期刊

Digestive Endoscopy 医学-外科

CiteScore

10.10

自引率

15.10%

发文量

291

审稿时长

6-12 weeks

期刊介绍： Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.