Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 4/2021

01-04-2021 | Esophagitis | Review Article

Efficacy of different endoscopic treatments in patients with gastroesophageal reflux disease: a systematic review and network meta-analysis

Authors: Peiwei Xie, Jing Yan, Ling Ye, Chong Wang, Yuanyuan Li, Youxiang Chen, Guohua Li

Published in: Surgical Endoscopy | Issue 4/2021

Login to get access

Abstract

Background

Both transoral incisionless fundoplication (TIF) and radiofrequency ablation (Stretta) are representative endoscopic treatments for gastroesophageal reflux disease (GERD), but they have not been directly compared. This systematic review and network meta-analysis (NMA) evaluated the comparative effects of Stretta, TIF, and proton pump inhibitors (PPIs).

Methods

PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Embase were searched for randomized controlled trials (RCTs) that compared the efficacy of either the Stretta, TIF, or PPIs/sham procedure for GERD treatment. The NMA was conducted using frequentist methods.

Results

A total of 516 participants from 10 RCTs were included in this NMA. Both Stretta (mean difference, MD − 9.77, 95% confidence interval, CI − 12.85 to − 6.70) and TIF (MD − 12.22, 95% CI − 15.93 to − 8.52) were significantly superior to PPIs at improving health-related quality of life (HRQL) scores and heartburn scores (Stretta: MD − 1.53, 95% CI − 2.98 to − 0.08; TIF: MD − 9.60, 95% CI − 17.79 to − 1.41). Stretta (MD − 3.77, 95% CI − 6.88 to − 0.65) was less effective at increasing lower esophageal sphincter (LES) pressure than TIF. Stretta was significantly superior to TIF (MD − 3.25, 95% CI − 5.95 to − 0.56) at improving esophageal acid exposure. Regarding the decrease in PPIs utility and esophagitis incidence, no significant differences were found between TIF and Stretta.

Conclusion

In terms of short-term reduction of the HRQL score and heartburn score in patients with GERD, TIF and Stretta may be comparable to each other, and both may be more effective than PPIs. TIF may increase the LES pressure in comparison with Stretta and PPIs. PPIs may reduce the percentage of time pH < 4.0 when compared with TIF. This evidence should be interpreted with caution given the small number of included studies and inherent heterogeneity.
Registration No. CRD42020188345.
Appendix
Available only for authorised users
Literature
1.
El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63:871–880PubMedCrossRef
2.
Peery AF, Crockett SD, Murphy CC, Lund JL, Dellon ES, Williams JL, Jensen ET, Shaheen NJ, Barritt AS, Lieber SR, Kochar B, Barnes EL, Fan YC, Pate V, Galanko J, Baron TH, Sandler RS (2019) Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2018. Gastroenterology 156:254PubMedCrossRef
3.
Everhart JE, Ruhl CE (2009) Burden of digestive diseases in the United States, Part I: overall and upper gastrointestinal diseases. Gastroenterology 136:376–386PubMedCrossRef
4.
Gisbert JP, Cooper A, Karagiannis D, Hatlebakk J, Agreus L, Jablonowski H, Nuevo J (2009) Impact of gastroesophageal reflux disease on work absenteeism, presenteeism and productivity in daily life: a European observational study. Health Qual Life Outcomes 7:90PubMedPubMedCentralCrossRef
5.
Farup C, Kleinman L, Sloan S, Ganoczy D, Chee E, Lee C, Revicki D (2001) The impact of nocturnal symptoms associated with gastroesophageal reflux disease on health-related quality of life. Arch Intern Med 161:45–52PubMedCrossRef
6.
Hunt R, Armstrong D, Katelaris P, Afihene M, Bane A, Bhatia S, Chen M-H, Choi MG, Melo AC, Fock KM, Ford A, Hongo M, Khan A, Lazebnik L, Lindberg G, Lizarzabal M, Myint T, Moraes-Filho JP, Salis G, Lin JT, Vaidya R, Abdo A, LeMair A (2017) World Gastroenterology Organisation Global Guidelines GERD global perspective on gastroesophageal reflux disease. J Clin Gastroenterol 51:467–478PubMedCrossRef
7.
Gyawali CP, Fass R (2018) Management of gastroesophageal reflux disease. Gastroenterology 154:302–318PubMedCrossRef
8.
Sifrim D, Zerbib F (2012) Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut 61:1340–1354PubMedCrossRef
9.
Fass R (2009) Proton pump inhibitor failure—what are the therapeutic options? Am J Gastroenterol 104:S33–S38PubMed
10.
Katz PO, Gerson LB, Vela MF (2013) Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 108:308–328PubMedCrossRef
11.
Richter JE (2013) Gastroesophageal reflux disease treatment: side effects and complications of fundoplication. Clin Gastroenterol Hepatol 11:465–471PubMedCrossRef
12.
Coron E, Sebille V, Cadiot G, Zerbib F, Ducrotte P, Ducrot F, Pouderoux P, Arts J, Le Rhun M, Piche T, des Varannes SB, Galmiche JP, Consortium de Recherche Indépendant sur le Traitement et L’exploration du Reflux Gastro-oesophagien et de L’endobrachyoesophage (CRITERE) (2008) Clinical trial: radiofrequency energy delivery in proton pump inhibitor-dependent gastro-oesophageal reflux disease patients. Aliment Pharmacol Ther 28:1147–1158
13.
Aziz AMA, El-Khayat HR, Sadek A, Mattar SG, McNulty G, Kongkam P, Guda MF, Lehman GA (2010) A prospective randomized trial of sham, single-dose Stretta, and double-dose Stretta for the treatment of gastroesophageal reflux disease. Surg Endosc Other Interv Tech 24:818–825CrossRef
14.
Hunter JG, Kahrilas PJ, Bell RCW, Wilson EB, Trad KS, Dolan JP, Perry KA, Oelschlager BK, Soper NJ, Snyder BE, Burch MA, Melvin WS, Reavis KM, Turgeon DG, Hungness ES, Diggs BS (2015) Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology 148:324-U108PubMedCrossRef
15.
Arts J, Bisschops R, Blondeau K, Farre R, Vos R, Holvoet L, Caenepeel P, Lerut A, Tack J (2012) A double-blind sham-controlled study of the effect of radiofrequency energy on symptoms and distensibility of the gastro-esophageal junction in GERD. Am J Gastroenterol 107:222–230PubMedCrossRef
16.
Corley DA, Katz P, Wo JM, Stefan A, Patti M, Rothstein R, Edmundowicz S, Kline M, Mason R, Wolfe MM (2003) Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial. Gastroenterology 125:668–676PubMedCrossRef
17.
Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JPA, Straus S, Thorlund K, Jansen JP, Mulrow C, Catala-Lopez F, Gotzsche PC, Dickersin K, Boutron I, Altman DG, Moher D (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162:777–784PubMedCrossRef
18.
Lipka S, Kumar A, Richter JE (2015) No evidence for efficacy of radiofrequency ablation for treatment of gastroesophageal reflux disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 13:1058–67.e1PubMedCrossRef
19.
Gerson L, Stouch B, Lobontiu A (2018) Transoral incisionless fundoplication (TIF 2.0): a meta-analysis of three randomized, controlled clinical trials. Chirurgia (Bucharest, Romania: 1990) 113:173–184CrossRef
20.
(2014) Review Manager (RevMan) [Computer program], Version 5.3. The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen
21.
StataCorp. (2017) Stata Statistical Software: Release 15. StataCorp LLC, College Station
22.
Chaimani A, Salanti G (2015) Visualizing assumptions and results in network meta-analysis: The network graphs package. Stata J 15:905–950CrossRef
23.
24.
Riley RD, Higgins JPT, Deeks JJ (2011) Interpretation of random effects meta-analyses. Br Med J (BMJ) 342:d549CrossRef
25.
Cipriani A, Higgins JPT, Geddes JR, Salanti G (2013) Conceptual and technical challenges in network meta-analysis. Ann Intern Med 159:130-W154PubMedCrossRef
26.
Dias S, Welton NJ, Caldwell DM, Ades AE (2010) Checking consistency in mixed treatment comparison meta-analysis. Stat Med 29:932–944PubMedCrossRef
27.
28.
Salanti G, Ades AE, Ioannidis JPA (2011) Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol 64:163–171PubMedCrossRef
29.
Puhan MA, Schuenemann HJ, Murad MH, Li T, Brignardello-Petersen R, Singh JA, Kessels AG, Guyatt GH, Grp GW (2014) A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. Br Med J (BMJ) 349:g5630CrossRef
30.
Salanti G, Del Giovane C, Chaimani A, Caldwell DM, Higgins JPT (2014) Evaluating the quality of evidence from a network meta-analysis. PLoS ONE 9(7):e99682PubMedPubMedCentralCrossRef
31.
Gyawali CP, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout AJPM, Vaezi M, Sifrim D, Fox MR, Vela MF, Tutuian R, Tack J, Bredenoord AJ, Pandolfino J, Roman S (2018) Modern diagnosis of GERD: the Lyon Consensus. Gut 67:1351–1362PubMedCrossRef
32.
Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA (1996) Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 183:217–224PubMed
33.
McCarty TR, Itidiare M, Njei B, Rustagi T (2018) Efficacy of transoral incisionless fundoplication for refractory gastroesophageal reflux disease: a systematic review and meta-analysis. Endoscopy 50:708–725PubMedCrossRef
34.
Huang X, Chen S, Zhao H, Zeng X, Lian J, Tseng Y, Chen J (2017) Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc 31:1032–1044PubMedCrossRef
35.
Perry KA, Banerjee A, Melvin WS (2012) Radiofrequency energy delivery to the lower esophageal sphincter reduces esophageal acid exposure and improves gerd symptoms: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 22:283–288PubMedCrossRef
36.
Fass R, Cahn F, Scotti DJ, Gregory DA (2017) Systematic review and meta-analysis of controlled and prospective cohort efficacy studies of endoscopic radiofrequency for treatment of gastroesophageal reflux disease. Surg Endosc Other Interv Tech 31:4865–4882CrossRef
37.
Savarino E, Bredenoord AJ, Fox M, Pandolfino JE, Roman S, Gyawali CP, International Working Group for Disorders of Gastrointestinal Motility and Function (2017) Advances in the physiological assessment and diagnosis of GERD. Nat Rev Gastroenterol Hepatol 14:665–676PubMedCrossRef
38.
Kim MS, Holloway RH, Dent J, Utley DS (2003) Radiofrequency energy delivery to the gastric cardia inhibits triggering of transient lower esophageal sphincter relaxation and gastroesophageal reflux in dogs. Gastrointest Endosc 57:17–22PubMedCrossRef
39.
Tam WCE, Schoeman MN, Zhang Q, Dent J, Rigda R, Utley D, Holloway RH (2003) Delivery of radiofrequency energy to the lower oesophageal sphincter and gastric cardia inhibits transient lower oesophageal sphincter relaxations and gastro-oesophageal reflux in patients with reflux disease. Gut 52:479–485PubMedPubMedCentralCrossRef
40.
Arts J, Sifrim D, Rutgeerts P, Lerut A, Janssens J, Tack J (2007) Influence of radiofrequency energy delivery at the gastroesophageal junction (the stretta procedure) on symptoms, acid exposure, and esophageal sensitivity to acid perfusion in gastroesophagal reflux disease. Dig Dis Sci 52:2170–2177PubMedCrossRef
41.
Vasiliadis KV, Viazis N, Vlachogiannakos J, Sgouros SN, Stefanidis G, Archimandritis A, Karamanolis DG (2010) Efficacy of three different dosages of esomeprazole in the long-term management of reflux disease: a prospective, randomized study, using the wireless Bravo pH system. Am J Gastroenterol 105:308–313PubMedCrossRef
42.
Trad KS, Barnes WE, Prevou ER, Simoni G, Steffen JA, Shughoury AB, Raza M, Heise JA, Fox MA, Mavrelis PG (2018) The TEMPO trial at 5 years: transoral fundoplication (TIF 2.0) is safe, durable, and cost-effective. Surg Innov 25:149–157PubMedPubMedCentralCrossRef
43.
Testoni PA, Testoni S, Mazzoleni G, Vailati C, Passaretti S (2015) Long-term efficacy of transoral incisionless fundoplication with Esophyx (Tif 2.0) and factors affecting outcomes in GERD patients followed for up to 6 years: a prospective single-center study. Surg Endosc Other Interv Tech 29:2770–2780CrossRef
44.
Noar M, Squires P, Noar E, Lee M (2014) Long-term maintenance effect of radiofrequency energy delivery for refractory GERD: a decade later. Surg Endosc Other Interv Tech 28:2323–2333CrossRef
45.
Hungin APS, Molloy-Bland M, Scarpignato C (2019) Revisiting Montreal: new insights into symptoms and their causes, and implications for the future of GERD. Am J Gastroenterol 114:414–421PubMedCrossRef
46.
Katzka DA, Pandolfino JE, Kahrilas PJ (2020) Phenotypes of gastroesophageal reflux disease: where Rome, Lyon, and Montreal meet. Clin Gastroenterol Hepatol 18:767–776PubMedCrossRef
47.
Savarino E, Zentilin P, Savarino V (2013) NERD: an umbrella term including heterogeneous subpopulations. Nat Rev Gastroenterol Hepatol 10:371–380PubMedCrossRef
48.
Kalapala R, Shah H, Nabi Z, Darisetty S, Talukdar R, Nageshwar Reddy D (2017) Treatment of gastroesophageal reflux disease using radiofrequency ablation (Stretta procedure): an interim analysis of a randomized trial. Indian J Gastroenterol 36:337–342PubMedCrossRef
49.
Witteman BPL, Conchillo JM, Rinsma NF, Betzel B, Peeters A, Koek GH, Stassen LPS, Bouvy ND (2015) Randomized controlled trial of transoral incisionless fundoplication vs. proton pump inhibitors for treatment of gastroesophageal reflux disease. Am J Gastroenterol 110:531–542PubMedCrossRef
50.
Trad KS, Barnes WE, Simoni G, Shughoury AB, Mavrelis PG, Raza M, Heise JA, Turgeon DG, Fox MA (2015) Transoral incisionless fundoplication effective in eliminating GERD symptoms in partial responders to proton pump inhibitor therapy at 6 months: the TEMPO randomized clinical trial. Surg Innov 22:26–40PubMedPubMedCentralCrossRef
51.
Rinsma NF, Farre R, Bouvy ND, Masclee AAM, Conchillo JM (2015) The effect of endoscopic fundoplication and proton pump inhibitors on baseline impedance and heartburn severity in GERD patients. Neurogastroenterol Motil 27:220–228PubMedCrossRef
52.
Hakansson B, Montgomery M, Cadiere GB, Rajan A, des Varannes SB, Lerhun M, Coron E, Tack J, Bischops R, Thorell A, Arnelo U, Lundell L (2015) Randomised clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD. Aliment Pharmacol Ther 42:1261–2127
Metadata
Title
Efficacy of different endoscopic treatments in patients with gastroesophageal reflux disease: a systematic review and network meta-analysis
Authors
Peiwei Xie
Jing Yan
Ling Ye
Chong Wang
Yuanyuan Li
Youxiang Chen
Guohua Li
Publication date
01-04-2021
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 4/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-021-08386-1

Other articles of this Issue 4/2021

Surgical Endoscopy 4/2021 Go to the issue

Correction

Correction to: Laparoscopic gastrectomy and metastasectomy for stage IV gastric cancer

OriginalPaper

Linear-array EUS improves the accuracy of predicting deep submucosal invasion in non-pedunculated rectal polyps compared with radial EUS: a prospective observational study

Dynamic Manuscript

Endoscopic preperitoneal parastomal hernia repair (ePauli repair) : an observational study

OriginalPaper

Perioperative and oncologic outcome of robot-assisted minimally invasive (hybrid laparoscopic and robotic) pancreatoduodenectomy: based on pancreatic fistula risk score and cancer/staging matched comparison with open pancreatoduodenectomy

OriginalPaper

Endoscopic vacuum therapy for treatment of rectal stump leakage

OriginalPaper

Oncological safety of transanal total mesorectal excision (TaTME) for rectal cancer: mid-term results of a prospective multicentre study