Schiefke I, Soeder H, Zabel-Langhennig A, Teich N, Neumann S, Borte G, Mössner J, Caca K
Depts of Internal Medicine II and Radiology, University of Leipzig, Leipzig, Germany.
Scand J Gastroenterol. 2004 Dec;39(12):1296-303. doi: 10.1080/00365520410003579.
Endoluminal gastroplication (EndoCinch) has emerged as an endoscopic anti-reflux therapy, but predictive factors for symptom relief have not been established. The aim of this study was to evaluate the major determinants to predict outcome in patients treated with EndoCinch.
A total of 53 consecutive patients, treated with EndoCinch at a single center were included in this prospective study. Inclusion criteria were symptoms of chronic heartburn, dependency on proton-pump inhibitors, documented pathological esophageal acid exposure, and a hiatal hernia smaller than 3 cm in length. All patients underwent endoscopy, 24-h pH monitoring, esophageal manometry, barium esophagram, and a detailed questionnaire regarding their symptoms before treatment. Patients were stratified into a responder and a non-responder group using a questionnaire at 3-month follow-up. A multivariate analysis was performed.
The success rate was 64% (34/53 patients). Three variables weresignificantly predictive for successful endoscopic anti-reflux treatment at the multivariate level: presence of typical symptoms (P=0.01), complete symptom relief with acid suppressive therapy (P=0.01), and normal lower esophageal sphincter pressure (P = 0.04). Not predictive of outcome were age, body mass index, esophagitis, other manometric findings, hiatal hernia size, or pathological level of pH <4/24 h. Barium esophagram did not add any additional predictive information.
Since no single factor can predict outcome after EndoCinch, a careful patient selection is mandatory to maximize the success rate. The ideal candidate for EndoCinch is a gastroesophageal (GERD) patient with a normal lower esophageal sphincter pressure, whose typical symptoms completely resolved with acid suppressive therapy.
腔内胃折叠术（EndoCinch）已成为一种内镜抗反流治疗方法，但症状缓解的预测因素尚未确定。本研究的目的是评估预测接受EndoCinch治疗患者预后的主要决定因素。
本前瞻性研究纳入了在单一中心接受EndoCinch治疗的53例连续患者。纳入标准为慢性烧心症状、对质子泵抑制剂的依赖、记录在案的病理性食管酸暴露以及长度小于3 cm的食管裂孔疝。所有患者在治疗前均接受了内镜检查、24小时pH监测、食管测压、食管钡餐造影以及关于其症状的详细问卷调查。在3个月随访时使用问卷将患者分为反应者组和无反应者组。进行了多变量分析。
成功率为64%（34/53例患者）。在多变量水平上，有三个变量对内镜抗反流治疗成功具有显著预测性：典型症状的存在（P = 0.01）、抑酸治疗后症状完全缓解（P = 0.01）以及食管下括约肌压力正常（P = 0.04）。年龄、体重指数、食管炎、其他测压结果、食管裂孔疝大小或pH<4/24小时的病理水平对预后无预测性。食管钡餐造影未增加任何额外的预测信息。
由于没有单一因素可以预测EndoCinch术后的预后，因此必须仔细选择患者以最大化成功率。EndoCinch的理想候选者是食管下括约肌压力正常、典型症状经抑酸治疗完全缓解的胃食管反流病（GERD）患者。
