Swedish Medical Center & SurgOne, P.C., 401 W. Hampden Place, Suite 230, Englewood, CO 80110, USA.
Surg Endosc. 2011 Jun;25(6):1975-84. doi: 10.1007/s00464-010-1497-9. Epub 2010 Dec 8.
Transoral treatment of gastroesophageal reflux disease (GERD) using the EsophyX device enables creation of an esophagogastric fundoplication with potential for better control of reflux than gastrogastric techniques. Efficacy and safety of a rotational/longitudinal esophagogastric transoral incisionless fundoplication (TIF) was evaluated retrospectively using subjective and objective outcomes.
Thirty-seven consecutive patients on antisecretory medication and with proven gastroesophageal reflux and limited hiatal hernia underwent TIF for persistent GERD symptoms. Five patients were reoperations for failed laparoscopic fundoplication.
Of the 37 treated patients, 57% were female. The median age was 58 (range=20-81) years and BMI was 25.5 (range=15.9-36.1) kg/m2. Sixty-eight percent indicated GERD-associated cough, asthma, or aspiration as a primary complaint and 32% complained of heartburn or regurgitation. The TIF procedures created tight wraps of 230°-330° extending 3-4 cm above the Z-line. Two complications occurred: one mediastinal abscess treated laparoscopically and one postoperative bleeding requiring transfusion. At 6 (range=3-14) months median follow-up TIF resulted in a significant improvement of both atypical and typical symptoms in 64% and 70-80% of patients, respectively, as indicated by the corresponding GERD health-related quality of life (HRQL) and reflux symptom index (RSI) score reduction by 50% or more compared to baseline on proton pump inhibitors (PPIs). No patient reported problems with dysphagia, bloating, or excess flatulence, and 82% were not taking any PPIs. Reflux characteristics were significantly improved and normalized in 61, 89, and 56% of patients in terms of acid exposure, number of refluxates, and DeMeester scores, respectively. TIF was effective in treating GERD in 75% of patients among whom 54% were in a complete "remission" and 21% were "improved." The remaining 25% were considered failures, and five (13.5%) patients underwent revision.
Rotational/longitudinal esophagogastric fundoplication using the EsophyX device significantly improved symptomatic and objective outcomes in over 70% of patients at median 6-month follow-up. Post-fundoplication side effects were not reported after TIF.
使用 EsophyX 设备经口治疗胃食管反流病 (GERD) 可实现食管胃底折叠术，与胃肠技术相比，其反流控制效果可能更好。本研究回顾性评估了一种旋转/纵向食管胃经口无切口折叠术 (TIF) 的疗效和安全性，采用主观和客观结局进行评估。
37 例接受抗分泌药物治疗且证实存在胃食管反流和有限食管裂孔疝的 GERD 患者因持续性 GERD 症状接受 TIF 治疗。5 例为腹腔镜胃底折叠术失败的再手术患者。
37 例治疗患者中，57%为女性。中位年龄为 58 岁（范围=20-81 岁），BMI 为 25.5kg/m2（范围=15.9-36.1kg/m2）。68%的患者将 GERD 相关咳嗽、哮喘或吸入作为主要主诉，32%的患者主诉烧心或反流。TIF 手术创建了 230°-330°的紧密包裹，比 Z 线高 3-4cm。发生了 2 种并发症：1 例纵隔脓肿，经腹腔镜治疗；1 例术后出血，需要输血。在中位随访 6 个月（范围=3-14 个月）时，与基线相比，质子泵抑制剂（PPI）治疗时，64%的患者典型和非典型症状显著改善，相应的胃食管反流病健康相关生活质量（HRQL）和反流症状指数（RSI）评分降低 50%或更多；70%-80%的患者分别改善了反流症状。没有患者报告出现吞咽困难、腹胀或过度嗳气的问题，82%的患者不再服用任何 PPI。在酸暴露、反流物数量和 DeMeester 评分方面，分别有 61%、89%和 56%的患者反流特征显著改善并恢复正常。TIF 治疗 GERD 的有效率为 75%，其中 54%的患者处于完全“缓解”状态，21%的患者处于“改善”状态。其余 25%的患者被认为是失败的，其中 5 例（13.5%）患者接受了翻修。
使用 EsophyX 设备进行的旋转/纵向食管胃底折叠术在中位 6 个月随访时显著改善了超过 70%患者的症状和客观结局。TIF 术后没有报告出现胃底折叠术相关副作用。
