氩离子凝固疗法治疗Barrett食管的系统评价

Argon plasma coagulation for Barrett's esophagus:a systematic review

目的系统评价氩离子凝固疗法(APC)治疗Barrett食管(BE)的有效性及安全性。方法计算机检索Cochrane图书馆2008年第2期、MEDLINE(1948.1～2008.10)、NCKI(1999.1～2008.10)。按Cochrane系统评价方法评价纳入研究的质量,并进行描述性分析。结果共纳入6个随机对照试验(RCT),包括患者253名。1个RCT试验显示APC疗法确能有效消融BE,随访1年,消融率为63%,对照组15%(P<0.01),5年为40%,对照组20%(P=0.027);3个RCT试验比较APC与光动力疗法(PDT),3个试验使用的光敏剂及激光照射方法均不同,未得到统一的结论;2个RCT试验比较APC与多极电凝(MPEC),meta分析表明二者的组织消融率无统计学差异[OR值0.81,95%CI(0.32,2.03)];4个RCT试验均有食管狭窄发生的报道。结论现有的证据表明APC疗法能够有效消融BE,且可维持较长时间;APC疗法与其他内镜消融疗法(PDT,MPEC)相比并无明显的优势,食管狭窄是APC疗法最常见的严重的副作用。

Objective To assess the efficacy and safety of argon plasma coagulation （APC） in treating patients with Barrett＇s esophagus. Methods Two reviewers independently searched the Cochrane Library （Issue 2, 2008）, MEDLINE （January 1948 to November 2008）, and CNKI （January 1999 to November 2008）, respectively. The quality of the included studies was assessed according to the guidance in the Cochrane Handbook of systematic reviews of interventions. Results Six randomized controlled trials involving 253 patients with Barrett＇s esophagus met the inclusion criteria and were included. One trial reported that the ablation rate of patients in the APC group was significantly higher than that in the endoscopic surveillance group. Followed up one year, the ablation rate in APC group was 63% compared with 15% in the control group （P^0.01）. Followed up 5 years, 40% patients who had undergone APC vs. 20% in the control group still had the reversal effect （P=0. 027）. Three trials were about the APC and photodynamic therapy （PDT）, but there were no consistent conclusions on which one was more effective in treating Barrett＇s esophagus. Meta-analysis of the other two trials demonstrated that there were no significant differences between the ablation rates of multipolar electrocoagulation （MPEC） and APC [OR O. 81, 95%CI （0.32, 2.03）]. Four trials reported the stricture of esophagus after APC. Conclusion Current evidence shows that APC can effectively ablate the Barrett mucosa and reverse to the coverage of squamous epithelium at the low esophagus. The reversal effect lasts for a long time, thus decreasing the incidence of esophageal adenocarcinoma. The most common adverse event of APC is stricture of esophagus. APC shows no advantages over other endoscopic ablative therapies （PDT or MPEC）.