Thomson M, Fritscher-Ravens A, Hall S, Afzal N, Ashwood P, Swain C P
Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK.
Gut. 2004 Dec;53(12):1745-50. doi: 10.1136/gut.2004.041921.
To describe paediatric experience, and to assess complications and therapeutic effectiveness of the use of endoluminal gastroplication in children with gastro-oesophageal reflux disease (GORD) refractory to, or dependent on, proton pump inhibitors.
Seventeen (five male) consecutive children/adolescents (median (range) age 12.4 (6.1-15.9) years, median (range) weight 46.0 (16.5-87.5) kg) with GORD either dependent for more than 12 months on proton pump inhibitors or non-responsive to medical treatment underwent endoscopic gastroplication using a flexible endoscopic sewing device (EndoCinch). Three plications were placed in gastric tissue below the lower oesophageal sphincter. Drug dose requirement, pH measurements, daily symptom severity and frequency, and validated reflux (QOLRAD) and general gastrointestinal (GSRS) quality of life scores were compared before and after endoscopic gastroplication.
All patients showed post-treatment improvement in symptom severity, frequency, and quality of life scores (p<0.0001). Three patients with recurrent symptomatic GORD had a repeat procedure within six weeks and did well subsequently. At up to 33 months of follow up (median 23), 14/17 patients remained off all antireflux medications, and 14/17 had maintained their symptomatic improvement. All pH parameters improved and had returned to normal values in 14/16 patients post-treatment and in 6/9 after one year of follow-up: in particular the reflux index had decreased from a median of 16.6% (0.9-67%) to 2.5% (0.7-15.7%) (p<0.0001) six weeks and 4.3% (2.2-20.6) (p<0.02) 12 months post-procedure. The only complication observed was gastric bleeding in one patient due to previously undiagnosed coagulopathy, which spontaneously resolved.
Endoluminal gastroplication is an effective and safe procedure in children/adolescents with significant GORD refractory to, or dependent on, medical anti-GORD therapy.
描述儿科经验，并评估腔内胃折叠术在对质子泵抑制剂难治或依赖的胃食管反流病（GORD）患儿中的并发症及治疗效果。
17例（5例男性）连续的儿童/青少年（年龄中位数（范围）12.4（6.1 - 15.9）岁，体重中位数（范围）46.0（16.5 - 87.5）kg），患有GORD，要么对质子泵抑制剂依赖超过12个月，要么对药物治疗无反应，使用柔性内镜缝合装置（EndoCinch）进行内镜下胃折叠术。在食管下括约肌下方的胃组织中放置三个折叠。比较内镜下胃折叠术前和术后的药物剂量需求、pH测量、每日症状严重程度和频率，以及经过验证的反流（QOLRAD）和一般胃肠道（GSRS）生活质量评分。
所有患者在症状严重程度、频率和生活质量评分方面均有治疗后改善（p<0.0001）。3例复发性有症状GORD患者在六周内进行了重复手术，随后情况良好。在长达33个月的随访（中位数23个月）中，17例患者中有14例停用了所有抗反流药物，17例中有14例症状持续改善。所有pH参数均有改善，16例患者中有14例在治疗后恢复正常，9例中有6例在随访一年后恢复正常：特别是反流指数在术后六周从中位数16.6%（0.9 - 67%）降至2.5%（0.7 - 15.7%）（p<0.0001），术后12个月降至4.3%（2.2 - 20.6）（p<0.02）。观察到的唯一并发症是1例患者因先前未诊断出的凝血病导致胃出血，出血自行缓解。
腔内胃折叠术对于对药物抗GORD治疗难治或依赖的严重GORD儿童/青少年是一种有效且安全的手术。
