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用于内镜下膜剖析的三个主要技术的执行:系统性审查和网络元分析

Daryl Ramai¹, Abdulrahman Qatomah^1,2, Magnus Chun³

¹Department of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, United States.

|June 25, 2025

概括

像道/口袋方法 (Tu-ESD) 和引方法 (Tr-ESD) 这样的内镜下粘膜切割 (ESD) 技术比传统方法 (C-ESD) 具有明显的优势. 图-ESD在治疗切除方面表现出色,而Tr-ESD则减少了手术时间并改善了块切除.

科学领域:

胃肠病学胃肠病学
手术创新在外科创新.
医疗技术评估医疗技术评估

背景情况:

内镜下粘膜剖析 (ESD) 是早期胃肠道癌症的标准.
对比不同ESD促进技术的证据有限.
优化ESD结果需要了解技术特定的好处.

研究的目的:

进行一个网络元分析,比较不同内镜下膜剖析 (ESD) 技术的疗效.
为了评估道/口袋方法 (Tu-ESD),引方法 (Tr-ESD) 和常规方法 (C-ESD).
评估结果,包括块切除,治愈切除,手术时间和不良事件.

主要方法:

随机对照试验 (RCT) 的系统审查和网络元分析.
包括18个RCT,包括2677名患者,比较Tu-ESD,Tr-ESD和C-ESD.
应用推,评估,发展和评价 (GRADE) 标准的评级,以评估证据质量.

主要成果:

在网络元分析中没有发现任何不一致性.
在治疗切除方面,TU-ESD的排名最高 (得分为92.1).
在缩短程序时间方面,Tr-ESD排名最高 (得分为100),并且与C-ESD (MD -18.74分钟) 相比,时间显著减少.
亚组分析表明Tr-ESD在块切除和手术时间方面的优势,而Tu-ESD在治疗切除和较少的不良事件方面表现出色.

结论:

图-ESD和Tr-ESD都是C-ESD的有效和安全替代品.
在特定的临床场景中,Tu-ESD和Tr-ESD提供了明显的优势.
对ESD的技术选择应根据患者和病变特征进行个性化.

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