Efficacy And Safety Of Argon Plasma Coagulation Therapy For Barrett’s Esophagus:A Meta-Analysis

Objective:To evaluate the efficacy and safety of argon plasma coagulation therapy for Barrett’s esophagus.Methods:Use argon plasma coagulation、APC、Barrett’s esophagus、BE as keywords, search PubMed、Embase、Cochrane Library Chinese Biomedical Literature Database(CBM)、Articles Database (WANGFANG)、Tsinghua Tongfang database (CNKI)and VTP database (VIP), which were published before March 2016, were searched for randomized controlled trials (RCTs) about treatment for Barrett’s esophagus.The treatment was about the argon plasma coagulation compared with surveillance or multipolar electrocoagulation or photodynamic therapy. The primary end point was endoscopic complete ablation histological complete ablation、progression to HGD and Buried glands.Some adverse such as stricture、photosensitivity、odynophagia、fever、 chest pain etc. were also analyzed. The data were analyzed by Revman 5.2 software.Results:A total of 16 studies with a sample size of 941 patients were included in this subject. The results of meta analysis showed that:compared to surveillance (OR=6.06,95%CI 2.64 to 13.93, P< 0.0001)、PDT (OR=6.34,95%CI 1.18 to 33.92, P=0.03<0.05)、PPI (OR=26.19,95%CI 10.96 to 62.59, P<0.00001),APC was more effective on histologically complete regression. No significant difference observed between APC and MPEC (OR=0.50,95%CI 0.19 to 1.30, P=0.15) on histologically complete regression. APC gets more effective on endoscopic complete regression than surveillance (OR=13.07,95%CI 3.46 to 49.44, P=0.0002<0.05), PPI(OR=26.19,95%CI 10.96 to 62.59, P<0.00001).In safety, compared to PDT theraphy, APC has less risk on chest pain (OR=0.20,95%CI 0.06 to 0.64, P=0.007< 0.05), photosensitivity(OR=0.10,95%CI 0.01 to 0.86, P=0.04<0.05)、elevated liver enzyme tests (OR=0.03,95%CI 0.00 to 0.24, P=0.0009<0.05), but there’s no significant difference between the two groups on Buried glands (OR=4.06, 95%CI 0.80 to 20.74, P=0.09>0.05)、stricture (OR=2.00,95%CI 0.45 to 8.93, P=0.36>0.05、odynophagia (OR=7.21,95%CI 0.13 to 407.64, P=0.34> 0.05)、 fever (OR=0.36,95%CI 0.08 to 1.63, P=0.18> 0.05). There’s no significant difference between APC and surveillance on progression to HGD (OR=0.26,95%CI 0.04 to 1.63, P=0.15>0.05、Buried glands (OR=1.84, 95%CI 0.50 to 6.78, P=0.36>0.05).Conclusions:For Barrett’s esophagus, APC has more effective on histologically and endoscopic complete regression than PDT、surveillance and PPI. APC is an effective and safety theraphy for Barrett’s esophagus.