Efficacy of Different Endoscopic Treatments for Gastroesophageal Reflux Disease: A Systematic Review and Network Meta-analysis

Background and Purpose There are no direct comparisons across different endoscopic therapies for gastroesophageal reflux disease (GERD). This study aims to evaluate the relative effects of different endoscopic therapies in GERD. Methods Five databases were searched until August2023 for RCTs that compared the efficacy of endoscopic band ligation (EBL), Stretta, endoscopic fundoplication (transoral incisionless fundoplication (TIF), endoscopic full-thickness placation (EFTP), endoCinch plication procedure (EndoCinch)) or PPIs/sham procedure for GERD. Bayesian network meta-analysis was performed. Results 19 trials comprising 1181 patients were included. EBL (MD: -7.75; 95% CrI: -13.90 to -1.44), Stretta (MD: -9.86; 95% CrI: -19.05 to -0.58), and TIF (MD: -12.58; 95% CrI: -20.23 to -4.91) all significantly improved patients’ health-related quality of life (HRQL) score with equivalent efficacy, compared with PPIs. TIF and EBL achieved equivalent efficacy in reducing PPIs utility (RR: 0.66; 95% CrI: 0.40 to 1.05) and both were significantly superior to other endoscopic interventions (Stretta, EFTP, and EndoCinch). Besides, EBL and TIF also could significantly decrease the esophagitis incidence compared with PPIs (EBL (RR: 0.34; 95% CrI: 0.22 to 0.48), TIF (RR: 0.38; 95% CrI: 0.15 to 0.88)). In terms of lower esophageal sphincter (LES) pressure, only TIF could significantly increase the LES pressure (MD: 6.53; 95% CrI: 3.65 to 9.40) to PPIs. In contrast, TIF was inferior to PPIs in decreasing esophageal acid exposure (MD: 2.57; 95% CrI: 0.77 to 4.36). Conclusion Combining the evidence, EBL and TIF may have comparable efficacy and both might be superior to Stretta, EFTP or EndoCinch in GERD treatment.