Efficacy of Different Endoscopic Treatments for Gastroesophageal Reflux Disease: A Systematic Review and Network Meta-analysis
Abstract
BACKGROUND AND PURPOSE
There are no direct comparisons across different endoscopic therapies for gastroesophageal reflux disease (GERD). This study aims to evaluate the relative effects of different endoscopic therapies in GERD.
METHODS
Five databases were searched until August2023 for RCTs that compared the efficacy of endoscopic band ligation (EBL), Stretta, endoscopic fundoplication (transoral incisionless fundoplication (TIF), endoscopic full-thickness placation (EFTP), endoCinch plication procedure (EndoCinch)) or PPIs/sham procedure for GERD. Bayesian network meta-analysis was performed.
RESULTS
19 trials comprising 1181 patients were included. EBL (MD: -7.75; 95% CrI: -13.90 to -1.44), Stretta (MD: -9.86; 95% CrI: -19.05 to -0.58), and TIF (MD: -12.58; 95% CrI: -20.23 to -4.91) all significantly improved patients' health-related quality of life (HRQL) score with equivalent efficacy, compared with PPIs. TIF and EBL achieved equivalent efficacy in reducing PPIs utility (RR: 0.66; 95% CrI: 0.40 to 1.05) and both were significantly superior to other endoscopic interventions (Stretta, EFTP, and EndoCinch). Besides, EBL and TIF also could significantly decrease the esophagitis incidence compared with PPIs (EBL (RR: 0.34; 95% CrI: 0.22 to 0.48), TIF (RR: 0.38; 95% CrI: 0.15 to 0.88)). In terms of lower esophageal sphincter (LES) pressure, only TIF could significantly increase the LES pressure (MD: 6.53; 95% CrI: 3.65 to 9.40) to PPIs. In contrast, TIF was inferior to PPIs in…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,181 participants or records.
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