S1069 Endoscopic vs Surgical Procedures for Gastroesophageal Reflux Disease - A Network Meta-Analysis
Abstract
Introduction: Various surgical fundoplication (SF) procedures have been the mainstay therapy for medication refractory GERD. Over the last couple of decades, interventional endoscopic procedures such as radiofrequency energy delivery with Stretta, endoscopic fundoplication (EF) procedures with EsophyX and GERDx systems, and laparoscopic magnetic sphincter augmentation (Linx), have emerged as alternative options. Objective of our study was to compare the e ffi cacy of these various procedures. Methods: A comprehensivesearchoftheavailableelectronicdatabases wasconducted,andonly RCTswithour proceduresofinterestwereincluded inournetworkmeta-analysisusingrandom-e ff ectsanalysis. Outcomes of interest were lower esophageal sphincter pressure (LESP), esophagitis, cessation of use of proton pump inhibitors (PPIs), and percentage of time with a pH less than 4 on a 24-hour esophageal pH monitoring (% time pH , 4) at a follow-up of one year or less. Results: Thirty-onestudieswithatotalof4,371patientswere includedintheanalysis.EFandSFwereassociatedwithsigni fi cantlyhigherLESPcomparedtoPPI.Therewasnosigni fi cantdi ff erencebetweenEF and Nissen [Mean Di ff erence (MD): 0.23, 95%CI: -7.01-7.48],
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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.
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