Reflux parameters as modified by EsophyX or laparoscopic fundoplication in refractory GERD
Reflux parameters as modified by EsophyX or laparoscopic fundoplication in refractory GERD
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DOI：
10.1111/j.1365-2036.2011.04677.x
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发表时间：
2011-07-01
影响因子：
7.6
通讯作者：
Melotti, G.
中科院分区：
文献类型：
--
作者：
Frazzoni, M.;Conigliaro, R.;Melotti, G.
背景EsophyX是一种新型的经口无切口胃底折叠装置，旨在模仿外科胃底折叠术。EsophyX胃底折叠术改善质子泵抑制剂（PPI）反应GERD患者的酸反流参数，但其在难治性GERD中的疗效几乎没有studyed.AimTo评估反流参数之前和之后EsophyX或腹腔镜胃底折叠术及其与难治性GERD.Methods症状的关系在一项开放标签研究中，我们前瞻性地招募患者，尽管高剂量PPI治疗胃灼热/反流持续。阻抗pH值监测进行PPI治疗前干预和关闭PPI治疗3个月后intervention.ResultsTen患者选择接受EsophyX（EndoGastric Solutions，雷德蒙，华盛顿州，美国）胃底折叠术，而10选择腹腔镜胃底折叠术，基线特征是可比的。手术组术后远端和近端返流显著减少，但内窥镜组未减少，前者的中位值显著低于后者。EsophyX后50%的病例和手术后100%的病例的食管酸暴露时间正常（P = 0.033）;分别有20%和90%的病例远端反流数量正常（P = 0.005），40%和100%的病例近端反流数量正常（P = 0.011）。术后6/10例EsophyX组患者和0/10例手术组患者中发现持续性胃底反流相关性（P = 0.011）。结论在难治性GERD患者中，EsophyX胃底折叠术在改善反流参数和诱导症状缓解方面的有效性明显低于腹腔镜胃底折叠术。营养药理学治疗2011; 34：67 - 75
BackgroundEsophyX is a novel transoral incisionless fundoplication device developed to mimic surgical fundoplication. EsophyX fundoplication improves acid reflux parameters in proton pump inhibitor (PPI)-responsive GERD patients but its efficacy in refractory GERD has been scarcely studied.AimTo assess reflux parameters before and after EsophyX or laparoscopic fundoplication and their relationship with symptoms in refractory GERD.MethodsIn an open-label study, we enrolled prospectively patients with heartburn/regurgitation persisting despite high-dose PPI therapy. Impedance-pH monitoring was performed on PPI therapy before intervention and off PPI therapy 3 months after intervention.ResultsTen patients chose to undergo EsophyX (EndoGastric Solutions, Redmond, WA, USA) fundoplication while ten chose laparoscopic fundoplication, and the baseline characteristics were comparable. Distal and proximal refluxes were significantly reduced post-operatively in the surgical but not in the endoscopic group and the median values were significantly lower in the former than in the latter. The oesophageal acid exposure time was normal in 50% of cases after EsophyX and in 100% of cases after surgery (P = 0.033); the number of distal refluxes was normal in 20% and 90% of cases (P = 0.005) and the number of proximal refluxes was normal in 40% and 100% of cases (P = 0.011), respectively. A positive persisting symptom-reflux association was found post-operatively in 6/10 patients in the EsophyX group and in 0/10 patients in the surgical group (P = 0.011).ConclusionsIn patients with refractory GERD, EsophyX fundoplication is significantly less effective than laparoscopic fundoplication in improving reflux parameters and accordingly, in inducing symptom remission. Aliment Pharmacol Ther 2011; 34: 67-75