Effect of transoral incisionless fundoplication on reflux mechanisms
Effect of transoral incisionless fundoplication on reflux mechanisms
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DOI：
10.1007/s00464-013-3250-7
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发表时间：
2014-03-01
影响因子：
3.1
通讯作者：
Conchillo, Jose M.
中科院分区：
文献类型：
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作者：
Rinsma, Nicolaas F.;Smeets, Fabienne G.;Conchillo, Jose M.
经口无切口胃底折叠术（TIF）是治疗胃食管反流病（GERD）的一种新的内镜治疗方法。这种新方法的抗反流作用的机制尚未研究。因此，我们进行了这项探索性研究，以评估TIF对反流机制的影响，重点是短暂的下食管括约肌松弛（TLESRs）和食管胃交界处（EGJ）的扩张性。GERD患者（N = 15; 11名男性，平均年龄41岁，范围23-66），不满意的药物治疗进行了研究之前和6个月后TIF。我们进行了餐后90分钟联合高分辨率测压和阻抗pH监测和24小时动态pH阻抗监测。在术前和术后即刻使用内窥镜功能性管腔成像探头评估EGJ扩张性，TIF减少了餐后TLESR的数量（16.8 +/- A 1.5 vs. 9.2 +/- A 1.3; p < 0.01）和与反流相关的餐后TLESR数量（11.1 +/- A 1.6 vs. 5.6 +/- A 0.6; p < 0.01），但与反流相关的TLESR比例不变（67.6 +/- A 6.9 vs. 69.9 +/- A 6.3%）。TIF还导致反流事件的数量和近端程度减少，直立位酸暴露改善;相反，TIF对气体反流事件的数量没有影响。术后EGJ扩张性降低（2.4 +/- A 0.3 vs. 1.6 +/- A 0.2 mm（2）/mmHg; p < 0.05）。TIF减少了餐后TLESR的数量，与反流和EGJ扩张性相关的TLESR数量。这导致反流事件的数量和近端程度减少，直立位酸暴露改善。TIF的抗反流作用仅对含液体的反流具有选择性，从而保留了胃排气的能力。
Transoral incisionless fundoplication (TIF) is a new endoscopic treatment option for gastroesophageal reflux disease (GERD). The mechanisms underlying the anti-reflux effect of this new procedure have not been studied. We therefore conducted this explorative study to evaluate the effect of TIF on reflux mechanisms, focusing on transient lower esophageal sphincter relaxations (TLESRs) and esophagogastric junction (EGJ) distensibility.GERD patients (N = 15; 11 males, mean age 41 years, range 23-66), dissatisfied with medical treatment were studied before and 6 months after TIF. We performed 90-min postprandial combined high-resolution manometry and impedance-pH monitoring and an ambulatory 24-h pH-impedance monitoring. EGJ distensibility was evaluated using an endoscopic functional luminal imaging probe before and directly after the procedure.TIF reduced the number of postprandial TLESRs (16.8 +/- A 1.5 vs. 9.2 +/- A 1.3; p < 0.01) and the number of postprandial TLESRs associated with reflux (11.1 +/- A 1.6 vs. 5.6 +/- A 0.6; p < 0.01), but the proportion of TLESRs associated with reflux was unaltered (67.6 +/- A 6.9 vs. 69.9 +/- A 6.3 %). TIF also led to a decrease in the number and proximal extent of reflux episodes and an improvement of acid exposure in the upright position; conversely, TIF had no effect on the number of gas reflux episodes. EGJ distensibility was reduced after the procedure (2.4 +/- A 0.3 vs. 1.6 +/- A 0.2 mm(2)/mmHg; p < 0.05).TIF reduced the number of postprandial TLESRs, the number of TLESRs associated with reflux and EGJ distensibility. This resulted in a reduction of the number and proximal extent of reflux episodes and improvement of acid exposure in the upright position. The anti-reflux effect of TIF showed to be selective for liquid-containing reflux only, thereby preserving the ability of venting gastric air.