Effect of electrical stimulation therapy of the lower esophageal sphincter in GERD patients with ineffective esophageal motility.
Effect of electrical stimulation therapy of the lower esophageal sphincter in GERD patients with ineffective esophageal motility.
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DOI：
10.1007/s00464-020-08104-3
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Schoppmann SF
中科院分区：
文献类型：
--
作者：
Paireder M;Kristo I;Asari R;Jomrich G;Steindl J;Rieder E;Schoppmann SF
食管下括约肌电刺激治疗（EST）是一种新的抗反流手术技术。由于在手术过程中LES的最小改变，LES-EST是胃食管反流病（GERD）和无效食管动力（IEM）患者的理想选择。这项前瞻性试验（NCT 03476265）的目的是评价GERD和IEM患者LES-EST后的健康相关生活质量和食管酸暴露。这是一项前瞻性、非随机、开放标签研究。纳入接受LES-EST的GERD和IEM患者。术后12个月的随访（FUP）包括使用标准化问卷（GERD-HRQL）进行的健康相关生活质量（HRQL）评估和食管功能测试。根据研究方案，17例患者符合合格标准。烧心和反流的HRQL评分分别从21（四分位距（IQR）15-27）改善至7.5（1.25-19），p = 0.001和从17（11-23.5）改善至4（0-12），p = 0.003。食管酸暴露没有显著改善，pH阻抗测量的反流事件数量也没有减少。远端收缩积分从64（11.5-301）改善至115（IQR 10-363）mmHg s cm，p = 0.249。无患者在LES-EST后出现任何吞咽困难体征。1例患者在1年后因电极导线断裂需要再次手术并重新植入LES-EST。尽管患者满意度在手术后显著提高，但本研究未能证明LES-EST后食管远端酸暴露的正常化或显著改善。
Electrical stimulation therapy (EST) of the lower esophageal sphincter (LES) is a novel technique in antireflux surgery. Due to the minimal alteration at the LES during surgery, LES-EST is meant to be ideal for patients with gastroesophageal reflux disease (GERD) and ineffective esophageal motility (IEM). The aim of this prospective trial (NCT03476265) is to evaluate health-related quality of life and esophageal acid exposure after LES-EST in patients with GERD and IEM. This is a prospective non-randomized open-label study. Patients with GERD and IEM undergoing LES-EST were included. Follow-up (FUP) at 12 months after surgery included health-related quality of life (HRQL) assessment with standardized questionnaires (GERD-HRQL) and esophageal functional testing. According to the study protocol, 17 patients fulfilled eligibility criteria. HRQL score for heartburn and regurgitation improved from 21 (interquartile range (IQR) 15–27) to 7.5 (1.25–19), p = 0.001 and from 17 (11–23.5) to 4 (0–12), p = 0.003, respectively. There was neither significant improvement of esophageal acid exposure nor reduction of number of reflux events in pH impedance measurement. Distal contractile integral improved from 64 (11.5–301) to 115 (IQR 10–363) mmHg s cm, p = 0.249. None of the patients showed any sign of dysphagia after LES-EST. One patient needed re-do surgery and re-implantation of the LES-EST due to breaking of the lead after one year. Although patient satisfaction improved significantly after surgery, this study fails to demonstrate normalization or significant improvement of acid exposure in the distal esophagus after LES-EST.
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DOI：
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发表时间：
2018-05-01
影响因子：
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作者：
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期刊：
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影响因子：
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