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 decreasing esophageal acid exposure (MD: 2.57; 95% CrI: 0.77 to 4.36).
Conclusion: Combining the evidence, EBL and TIF may have comparable efficacy and both might be superior to Stretta, EFTP or EndoCinch in GERD treatment.
Keywords: Endoscopy; Fundoplication; GERD; Ligation; Stretta.
Copyright © 2024. Published by Elsevier Inc.