The Photodynamic Therapy On The Treatment Of Barrett’s Esophagus:a Systematic Review And Meta-analysis

Objectives:Evaluate the efficacy of photodynamic therapy(PDT) for the treatment of patients with Barrett’s esophagus(BE), and further more systematically evaluate the consequents and side effects of PDT versus APC on the treatment of BE.Data Sources:Two investigators searched the published English-or Chinese-language literatures independently from the databases like Medline (1990～2014)、Embase (1990～2014)、Cochrone Library(2014, Issue4)、CBMdisc (1990～2014)、CNKI(1990～2014)、Wanfang(1990～2014)and Vip(1990～2014). The search was limited to clinical randomized controlled trial(RCT). All RCTs about PDT versus placebo or APC were accepted.Methods:RevMan5.2and Stata12.0were employed for the systematic review and meta-analysis after screening the literatures, extracting the datas and evaluating the qualities and bias.Results:There are8literatures or7trials including428patients were enrolled in our research. Our analysis showed that PDT was effective in the treatment of BE[OR=12.97,95%CI (1.08～155.4), P=0.04<0.05] and the main side effects were nausea&vomitting, photosensitivity and esophagostenosis. Further more, PDT was not as excellent as APC in the effect of BE’s epidermal clearance[OR=0.34,95%CI (0.18～0.66), P=0.001<0.05], while the occurance of the buried glands was lower than APC[OR=0.24,95%CI (0.09～0.65), P=0.005<0.05], which indicated that there was lower risk of relapse and canceration of BE after the treatment. Some of the side effects of PDT were worse than APC, such as nausea&vomitting[OR=20.5,95%CI (2.62～160.43), P=0.004<0.05], photosensitivity [OR=9.32,95%CI (1.09～79.49), P=0.04<0.05], liver dysfunction[OR=31.89,95%CI(3.94～258.1), P=0.001<0.05] and chest pain[OR=1.04,95%CI (0.1～10.77), P=0.97>0.05], but there was no statistical significance on the difference of chest pain. Esophagostenosis of PDT was minor than APC[OR=0.61,95%CI (0.11～3.44), P=0.57>0.05], also with no statistical significance on this difference. We had no exact result about odynophagia.Conculsion:PDT was effective in the treatment of BE and the main side effects were nausea&vomitting, photosensitivity and esophagostenosis. Further more, PDT was not as excellent as APC in the effect of BE’s epidermal clearance, while the occurance of the buried glands was lower than APC, which indicated that there was lower risk of relapse and canceration of BE after the treatment. Some of the side effects of PDT were worse than APC, like nausea&vomitting, photosensitivity, liver dysfunction and chest pain, but there was no statistical significance on the difference of chest pain. Esophagostenosis of PDT was minor than APC, also with no statistical significance on this difference. We had no exact result about odynophagia. No publication bias existed.