Network meta‐analysis of surgical management of gastro‐oesophageal reflux disease in adults. BJS 2018; 105: 1398-1407.
Published: 13th July 2018
Authors: M. A. Amer, M. D. Smith, C. H. Khoo, G. P. Herbison, J. L. McCall
Proton pump inhibitors are the mainstay of treatment for gastro‐oesophageal reflux disease, but are associated with ongoing costs and side‐effects. Antireflux surgery is cost‐effective and is preferred by many patients. A total (360o or Nissen) fundoplication is the traditional procedure, but other variations including partial fundoplications are also commonly performed, with the aim of achieving durable reflux control with minimal dysphagia. Many RCTs and some pairwise meta‐analyses have compared some of these procedures but there is still uncertainty about which, if any, is superior. Network meta‐analysis allows multiple simultaneous comparisons and robust synthesis of the available evidence in these situations. A network meta‐analysis comparing all antireflux procedures was performed to identify which has the most favourable outcomes at short‐term (3–12 months), medium‐term (1–5 years) and long‐term (10 years and more than 10 years) follow‐up.
Article databases were searched systematically for all eligible RCTs. Primary outcomes were quality‐of‐life measures and dysphagia. Secondary outcomes included reflux symptoms, pH studies and complications.
Fifty‐one RCTs were included, involving 5357 patients and 14 different treatments. Posterior partial fundoplication ranked best in terms of reflux symptoms, and caused less dysphagia than most other interventions including Nissen fundoplication. This was consistent across all time points and outcome measures.
Posterior partial fundoplication provides the best balance of long‐term, durable reflux control with less dysphagia, compared with other treatments.Full text
You may also be interested in
Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer.
Authors: J. A. Elliott, L. O'Byrne, G. Foley, C. F. Murphy, S. L. Doyle, S. King et al.
Quality assurance of surgery in the randomized ST03 trial of perioperative chemotherapy in carcinoma of the stomach and gastro‐oesophageal junction.
Authors: W. H. Allum, E. C. Smyth, J. M. Blazeby, H. I. Grabsch, S. M. Griffin, S. Rowley et al.
Meta‐analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis.
Authors: N. Moody, A. Adiamah, F. Yanni, D. Gomez
Authors: Y. Y. Broza, S. Khatib, A. Gharra, A. Krilaviciute, H. Amal, I. Polaka et al.
Authors: S. Ahlin, C. Cefalù, I. Bondia‐Pons, E. Capristo, L. Marini, A. Gastaldelli et al.
Development and validation of a staging system for gastric adenocarcinoma after neoadjuvant chemotherapy and gastrectomy with D2 lymphadenectomy.
Authors: J. X. Lin, C. Yoon, J. Desiderio, B. C. Yi, P. Li, C. H. Zheng et al.
Hepatectomy for hepatocellular carcinoma after perioperative management of portal hypertension. BJS 2019; 106: 1066-1074.
Authors: N. Takemura, T. Aoki, K. Hasegawa, J. Kaneko, J. Arita, N. Akamatsu et al.
Meta‐analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy. BJS 2019; 106: 534-547.
Authors: D. Schizas, M. Kosmopoulos, S. Giannopoulos, S. Giannopoulos, D. G. Kokkinidis, N. Karampetsou et al.
Changes in gut hormones, glycaemic response and symptoms after oesophagectomy. BJS 2019; 106: 735-746.
Authors: J. A. Elliott, N. G. Docherty, C. F. Murphy, H.‐G. Eckhardt, S. L. Doyle, E. M. Guinan et al.
Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer. BJS 2019; 106: 596-605.
Authors: S. E. Vollenbrock, F. E. M. Voncken, J. M. van Dieren, D. M. J. Lambregts, M. Maas, G. J. Meijer et al.
Major hepatectomy with or without pancreatoduodenectomy for advanced gallbladder cancer. BJS 2019; 106: 626-635.
Authors: T. Mizuno, T. Ebata, Y. Yokoyama, T. Igami, J. Yamaguchi, S. Onoe et al.