Fundoplication is superior to medical therapy for Barrett's esophagus disease regression and progression: a systematic review and meta-analysis.

摘要: BACKGROUND Fundoplication and medical management are current mainstays for of Barrett's esophagus (BE), however our understanding differences in outcomes between these two treatments is limited. The aim this study was to perform a systematic review meta-analysis evaluate the efficacy interventions on BE disease regression progression. METHODS AND PROCEDURES A comprehensive search MEDLINE, EMBASE, Scopus, Web Science, Cochrane Library databases performed February 22, 2021. Inclusion criteria were studies with both surgical comparators, diagnosis prior treatment, patients aged ≥ 18 years, greater than five patients. Primary interest included evaluating changes histopathologic progression interventions. Meta-analysis using Mantel-Haenszel random-effects model (RevMan 5.4.1). RESULTS total 7231 retrieved after initial nine (1 randomized trial, 7 prospective cohorts, 1 retrospective cohort) meeting final inclusion criteria. Of studies, 890 (65%) received while 470 (35%) management. Medical proton pump inhibitors (n = 807, 91%; 6 studies), H2-receptor blockers (n = 40, 4% patients; 3 combination therapy (n = 43, 5%; study). Nissen fundoplication most commonly type (n = 265, 93%). Median length follow-up ranged from 1.5-7 years. revealed that associated improved metaplasia/low-grade dysplasia (OR 4.38; 95% CI 2.28-8.42; p < 0.00001) dysplasia/adenocarcinoma 0.34; 0.12-0.96; p = 0.04) compared therapy. CONCLUSION superior regards odds Additional trials which directly compare intervention required delineate optimal delivery timing