Gastroesophageal Reflux after Stapler-assisted Mucosectomy in inverse-NOTES technique for Barretts Esophagus

Barrett 食管吻合器辅助粘膜切除术 inverse-NOTES 技术后胃食管反流

• 批准号: 322730519
• 负责人: Dr. Philip Müller
• 金额: --
• 依托单位: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2016
• 资助国家: 德国
• 起止时间: 2015-12-31 至 2016-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/322730519?language=en
• 关键词: Gastroesophageal; Reflux; after; Stapler; assisted

Gastroesophageal reflux disease (GERD) leads to the replacement of squamous epithelium by intestinal mucosa in the distal esophagus (Barretts epithelium, BE). BE is a facultative precancerosis that can result in an invasive adenocarcinoma. Currently, close endoscopic surveillance is recommended for early detection of dysplasia or invasive cancer. The current treatment for dysplastic BE is endoscopic mucosal resection (EMR) or, alternatively, radiofrequency ablation. EMR makes histological analysis difficult due to resection of the specimen in pieces (piecemeal), but it is critical to assess the resection margins in cases with high-grade dysplasia or invasive cancer. A larger resection field, or even circular resection, presents a substantial risk for post- intervention strictures. Advanced BE with high-grade dysplasia that is not amenable to EMR is currently treated by esophagectomy, which is considered an invasive high-risk surgical procedure. There we devoloped a minimally invasive surgical technique for local mucosectomy for BE providing a circumferential en-bloc specimen suitable for further analysis. By a transgastric approach, a laparoscope is inserted into the stomach through the abdominal and gastric walls, and a pneumogastrium is established. In stapler-assisted mucosectomy (SAM) an intact, circumferential en-bloc specimen is obtained and stricture formation is prevented by avoiding open wound healing. We have demonstrated the feasibility of this novel method in a non-survival as well as in a survival porcine model. It has been demonstrate that the procedure is safe and that no strictures occur within 6 weeks. However, as patients with BE almost exclusively suffer from GERD the SAM procedure should be accompanied by antireflux surgery such as fundoplication. In SAM a circumferential mucosal resection with reconnection of the mucosa using circular staples is performed. This circumferential staple line could theoretically impair the function of the lesser esophageal sphincter. The experiment of this proposal will therefore evaluate the questions if SAM has an influence on GERD, if SAM could be combined with Nissen-fundoplication and if fundoplication is an effective antireflux procedure in combination with SAM. The successful implementation of SAM could change the way BE and GERD are treated. The combination of SAM and an antireflux procedure could allow patients with GERD and BE to be effectively treated long-term in a single-session, unlike current therapeutic options.

胃食管反流病（GERD）导致食管远端鳞状上皮被肠粘膜（Barretts上皮，BE）替代。BE是一种可导致浸润性腺癌的兼性癌前病变。目前，密切的内镜监测被推荐用于异型增生或浸润性癌症的早期检测。目前异型增生BE的治疗方法是内镜下粘膜切除术（EMR）或射频消融术。EMR使组织学分析变得困难，因为切除的标本是碎片（零碎的），但在高度异型增生或浸润性癌症的情况下，评估切除边缘至关重要。更大的切除野，甚至是环形切除，存在介入后狭窄的重大风险。不适合EMR的晚期BE伴高度异型增生目前通过食管切除术治疗，这被认为是一种侵入性高风险外科手术。在那里，我们开发了一种微创手术技术，用于BE的局部粘膜切除术，提供了适合进一步分析的环形整块标本。通过经胃途径，将腹腔镜通过腹壁和胃壁插入胃中，并建立胃积气。在吻合器辅助粘膜切除术（SAM）中，获得了完整的环形整块标本，并通过避免开放性伤口愈合来防止狭窄形成。我们已经证明了这种新方法在非存活以及存活猪模型中的可行性。已经证明该手术是安全的，并且在6周内没有狭窄发生。然而，由于BE患者几乎完全患有GERD，SAM手术应伴随抗反流手术，如胃底折叠术。在SAM中，使用圆形斯台普斯进行环周粘膜切除并重新连接粘膜。该环形缝钉线理论上可能会损害食管小括约肌的功能。因此，本建议的实验将评估SAM是否对GERD有影响、SAM是否可以与尼森胃底折叠术结合以及胃底折叠术与SAM结合是否是一种有效的抗反流手术。SAM的成功实施可能会改变BE和GERD的治疗方式。SAM和抗反流程序的组合可以使GERD和BE患者在单次治疗中得到长期有效的治疗，这与目前的治疗选择不同。

项目成果

Feasibility and effectiveness of laparoscopic transgastric stapler-assisted circumferential esophageal mucosectomy and simultaneous fundoplication in a pig model.

• DOI: 10.1093/dote/doy030
• 发表时间: 2018-10-01
• 期刊: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
• 作者: Steinemann DC;Müller PC;Schwarz AC;Zerz A;Linke GR;Müller-Stich BP
• 通讯作者: Müller-Stich BP