The Effects Of Balloon Dilatation On Post-stroke Dysphagia:Systemic Review And Meta-analysis

ObjectiveTo assess the effects and safety of balloon dilatation on post-stroke dysphagia by systematic review.MethodsWe systematically searched for all relevant articles in electronic databases(Cochrane Library,PubMed,CNKI,WANGFANG DATA and VIP)from their earliest record to 27 November 2017.We included just randomized controlled trials published in English and Chinese language.The eligible articles were assessed for The Cochrane Collaboration's tool for assessing risk of bias.Two reviewers independently extracted the data and assessed the methodological quality;A consensus method was used to solve disagreements.Meta-analysis was performed using Review Manager Software 5.3.OR and WMD were chosen as binary and continuous outcomes respectively.Results22 RCTs were included,involving 890 patients,which 446 cases in the treatment group and 444 patients in the control group.The methodological quality evaluation results were"Unclear risk of bias".1.21 RCTs included 860 patients compared balloon dilatation combined with conventi-onal swallowing rehabilitation methods and conventional swallowing rehabilitation:1)The effective rate:balloon dilatation combined with conventional swallowing rehabi-litation methods were superior to conventional swallowing rehabilitation methods[OR 5.90,95%CI(3.44,10.12)];2)The cured rate:balloon dilatation combined with conventional swallowing rehabilita-tion methods were superior to conventional swallowing rehabilitation methods[OR 3.66,95%CI(1.89,7.09)];3)Compared with conventional swallowing rehabilitation methods,balloon dilatation combined with conventional swallowing rehabilitation methods was more effective in improving VFSS score[WMD 2.24,95%CI(1.93,2.55)],Dysphagia score[WMD 3.18,95%CI(2.4.3.96)],FOIS score[WMD 0.56,95%CI(0.21,0.91)],Watian swallowing ability[WMD-1.09,95%CI(-1.49,-0.86)],SAA score[WMD-3.04,95%CI(-4.61,-1.47)];4)Compared with conventional swallowing rehabilitation methods,balloon dilatation combined with conventional swallowing rehabilitation methods was more effective in improving VFSS cricopharyngeus open[OR 7.68.95%CI(3.05,19.36)],Oral Intake ability[OR 5.20,95%CI(3.63,7.46)];5)Compared with conventional swallowing rehabilitation methods,balloon dilatation combined with conventional swallowing rehabilitation methods was more effective in improving VFSS pharyngeal passage time[WMD-0.07,95%CI(-0.07,-0.06)];the indwelling gastric tube time[WMD-6.33,95%CI(-7.11,-5.55)],Hospitalization time[WMD-6.38.95%CI(-7.40,-5.36)].Remove the gastric tube[OR 27.00,95%CI(4.57,159.66)].6)Balloon dilatation combined with conventional swallowing rehabilitation methods and conventional swallowing rehabilitation methods had a same effect in reducing the incidence of aspiration pneumonia[OR 0.55,95%CI(0.18,1.62)];7)No complications were found in both balloon dilatation combined with conventional swallowing rehabilitation methods and conventional swallowing rehabilitation methods.2.1 RCTs included 30 patients compared balloon dilatation and conventional swallowing rehabilitation methods:balloon dilatation and conventional swallowing rehabilitation methods had a same effective rate[OR 4.33,95%CI(0.71,26.53)];Hower,compared with conventional swallowing rehabilitation methods,balloon dilatation was more effective in improving VFSS score[WMD 2.74,95%CI(1.74,3.74)],VFSS pharyngeal passage time[WMD-0.06,95%CI(-0.08,-0.04)].3.The quality of evidence of data analysis results is graded as low by the GRADE system.ConclusionBalloon dilatation combined with conventional swallowing rehabilitation methods for the improvement of post-stroke dysphagia has a positive effect,high safety.Attention should be paid to relevant factors affecting the treatment effect,and further high-quality clinical randomized controlled trials should be performed to provide more reliable evidence for balloon dilatation on post-stroke dysphagia.