Thomson Mike, Antao Brice, Hall Sharon, Afzal Nadeem, Hurlstone Paul, Swain C Paul, Fritscher-Ravens Annette
Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, UK.
J Pediatr Gastroenterol Nutr. 2008 Feb;46(2):172-7. doi: 10.1097/MPG.0b013e31814d4de1.
Endoluminal gastroplication (EG) is emerging as a minimally invasive procedure for the treatment of gastroesophageal reflux disease (GERD). The aim of this study is to evaluate the medium-term outcomes after EG in a pediatric patient population.
Seventeen children with a median age of 12.4 years (range 6.1-15.9 years) with GERD underwent EG using a flexible endoscopic sewing device (EndoCinch) over a period of 3 years. Three plications were placed in the gastric tissue below the lower esophageal sphincter. Drug dose requirement, pH measurements, symptom severity and frequency, and validated Quality of Life in Reflux and Dyspepsia (QOLRAD) scores were compared before EG and 1 and 3 years after EG. Statistical analysis was performed using a Wilcoxon rank-sum test and P < 0.05 was the threshold for significance.
All patients showed an immediate posttreatment improvement in symptom severity, symptom frequency, and quality of life scores. Completed 1- and 3-year data were obtained from 16 patients. Four cases (25%) required a repeat procedure as a result of recurrence of symptoms after 2 to 24 months. Fourteen patients (88%) at 1 year and 9 patients (56%) at 3 years remained without a need for any antireflux medication. A sustained improvement in heartburn (P = 0.004), regurgitation (P = 0.017), and vomiting (P = 0.018) was seen at 3 years. The total QOLRAD score (maximum of 175) improved from a median of 87 (range 69-142) to 156 (range 111-175) at 1 year (P < 0.0001) and 153.5 (range 55-174) at 3 years (P = 0.002).
EG is an effective and safe procedure in children. It is a viable option for the treatment of GERD refractory to or dependent on antireflux medications.
腔内胃折叠术（EG）正逐渐成为治疗胃食管反流病（GERD）的一种微创手术。本研究的目的是评估儿童患者接受EG治疗后的中期疗效。
17例GERD患儿，中位年龄12.4岁（范围6.1 - 15.9岁），在3年期间使用柔性内镜缝合装置（EndoCinch）接受了EG治疗。在食管下括约肌下方的胃组织中进行了三次折叠。比较了EG治疗前、治疗后1年和3年的药物剂量需求、pH测量值、症状严重程度和频率以及经过验证的反流和消化不良生活质量（QOLRAD）评分。采用Wilcoxon秩和检验进行统计分析，P < 0.05为显著性阈值。
所有患者治疗后症状严重程度、症状频率和生活质量评分均立即改善。从16例患者获得了完整的1年和3年数据。4例（25%）患者因症状在2至24个月后复发而需要重复手术。14例（88%）患者在1年时、9例（56%）患者在3年时无需任何抗反流药物。在3年时，烧心（P = 0.004）、反流（P = 0.017）和呕吐（P = 0.018）症状持续改善。总的QOLRAD评分（最高175分）从治疗前的中位数87分（范围69 - 142分）在1年时提高到156分（范围111 - 175分）（P < 0.0001），在3年时提高到153.5分（范围55 - 174分）（P = 0.002）。
EG在儿童中是一种有效且安全的手术。它是治疗对抗反流药物难治或依赖的GERD的可行选择。
