Safety and efficacy of endoscopic and surgical anti-reflux procedures for gastroesophageal reflux disease: a systematic review and network meta-analysis
10.3760/cma.j.cn441530-20250724-00280
- VernacularTitle:内镜与外科抗反流手术治疗胃食管反流病的疗效及安全性比较：一项系统评价与网状Meta分析
- Author:
Huiting LIN
1
;
Qianjun ZHUANG
1
;
Junnan HU
1
;
Yinglian XIAO
1
Author Information
1. 中山大学附属第一医院消化内科，广州 510080
- Publication Type:Journal Article
- Keywords:
Gastroesophageal reflux disease;
Anti-reflux procedures;
Endoscopic therapy;
Fundoplication
- From:
Chinese Journal of Gastrointestinal Surgery
2025;28(10):1161-1178
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study aims to conduct a systematic review and network meta-analysis comparing the safety and efficacy of endoscopic versus surgical treatments for gastroesophageal reflux disease (GERD).Methods:Randomized controlled trials were identified through systematic searches of MEDLINE, Embase, Web of Science, and CNKI. Both direct effect models and Bayesian random-effects network meta-analysis were used to compare treatments directly and indirectly. The following types of studies were included : (1) RCTs involving endoscopic or surgical treatment for adult GERD patients aged ≥18 years with no previous history of gastroesophageal surgery; (2) studies comparing two or more treatment methods, including different endoscopic or surgical procedures, proton pump inhibitor (PPI) therapy, and/or sham surgery; and (3) articles published in Chinese or English. Review articles and conference abstracts were excluded.Results:A total of 47 randomized controlled trials were enrolled, and 43 studies were network meta-analyzed. Both endoscopic and surgical treatments significantly reduced postoperative PPI use compared to PPI therapy ( P <0.05). Among all treatment modalities, laparoscopic Nissen fundoplication (LNF, SUCRA=0.84) demonstrated the highest efficacy, followed by laparoscopic Toupet fundoplication (LTF, SUCRA=0.71) and anterior partial fundoplication (APF, SUCRA=0.70). Transoral incisionless fundoplication (TIF) demonstrated the best outcomes in relieving heartburn (SUCRA=0.87) and bloating (SUCRA=0.86) symptoms. The overall safety of surgical treatment was comparable to that of PPI therapy. However, LNF was associated with a higher incidence of postoperative dysphagia and gas-related symptoms, whereas TIF had a lower risk of postoperative complications. Conclusions:Both endoscopic and surgical treatments are effective for GERD. LNF provides the highest rate of medication discontinuation but carries a higher risk of postoperative complications. TIF offers better relief of heartburn and bloating with fewer complications.
