黏膜切除治疗Barrett食管疗效及安全性的Meta分析

Meta-analysis of effect and safety of endoscopic mucosal resection in treating Barrett esophagus

目的评价黏膜切除（EMR）对于Barrett食管（BE）治疗的有效性、持久性及不良事件发生率。方法计算机检索Embase、PubMed、维普、中国期刊全文数据库、万方数字化期刊全文数据库等。提取各病理类型的BE接受EMR治疗后根除肠上皮化生（CE-IM）、上皮内瘤变（CE-N）的比率,治疗随访期间肠上皮化（IM）或瘤变复发及不良事件发生率,应用R3.1.3软件合并数据进行统计学分析,计算其有效性、持久性及不良事件发生率。结果共纳入4篇研究,总病例130例。EMR治疗异型增生或黏膜内癌的BE患者中,达到CE-N为97%（95%CI：0.91~0.99）,达到CE-IM为91%（95%CI：0.83~0.95）,在随访过程中瘤变或IM复发率为8%,常见并发症食管狭窄与出血,其发生率分别为39%和6%。结论 EMR作为BE内镜治疗的推荐方式,其在治疗伴异型增生或黏膜内癌的BE上有确切的效果,但其并发症特别是食管狭窄发生率较高。

Objective To evaluate the effectiveness,persistence and incidence of adverse events of endoscopic mucosal resection（EMR）for the treatment of Barrett esophagus（BE）.Methods The full-tex databases of Embase,PubMed,VIP,CNKI,Wanfang database were retrieved by computer.The proportion of eradication of intestinal metaplasia（CE-IM）and neoplasia（CE-N）,recurrence of intestinal metaplasia（IM）and adenocarcinoma,and adverse events occurred during the follow-up after receiving ENR in different pathological types of BE were extracted.The extracted data were pooled and statistically analyzed by using the R3.1.3software.Results 4researches were included,involving130 patients.In the patients with high grade dysplasia（HGD）or intramucosal carcinoma treated by EMR,reached CE-N was 97%（95%CI：0.91-0.99）,reached CE-IM was 91%（95%CI：0.87-0.94）,neoplasia or IM recurrence rate was 8%,the esophageal stricture and bleeding were common,their incidence rates were 39% and 6%respectively.Conclusion EMR as the recommend mode for BE endoscopic therapy has definite effect in treating BE complicating dysplasia or intramucosal carcinoma,but has the higher occurrence rate of complications,especially esophageal stricture.