Hopkins Jessica, Switzer Noah J, Karmali Shahzeer
Jessica Hopkins, Noah J Switzer, Shahzeer Karmali, Department of Surgery, University of Alberta, Edmonton, Alberta T6G 2B7, Canada.
World J Gastrointest Endosc. 2015 Aug 25;7(11):1039-44. doi: 10.4253/wjge.v7.i11.1039.
Endoscopic treatments for gastroesophageal reflux disease (GERD) have become increasingly popular in recent years. While surgical intervention with the Laparoscopic Nissen Fundoplication remains the gold standard, two endoscopic interventions, specifically, are gaining traction in clinical use (EsophyX and Stretta). The EsophyX (EndoGastric Solutions, Inc., Redmond, WA, United States) was developed as a method of restoring the valve at the GE junction through an endoluminal fundoplication (ELF) technique. Long-term data suggests that transoral incisional fundoplication (TIF) with EsophyX may be effective for symptom control and proton pump inhibitor reduction or cessation for up to 2-6 years. There is no evidence that EsophyX is more effective than surgical intervention. TIF may be most effective for patients with HH < 2 cm and Hill Grade I/II valves. Stretta (Mederi Therapeutics, Greenwich, CT, United States) was approved by the Food and Drug Administration in 2000. It delivers radiofrequency energy to the lower esophageal sphincter and gastric cardia. Published reviews of the literature are conflicted in their recommendations of Stretta in the management of GERD. The literature suggests that the Stretta procedure has an acceptable safety profile and may be effective in reducing symptom burden and quality of life scores up to 8 years post-intervention. However, there does not appear to be any sustained improvement in objective outcomes and there is no evidence that Stretta results in improved outcomes as compared to surgical intervention. Treatment modalities for GERD, as a field, suffer from a lack of standardization in primary and secondary outcomes. Although many studies have looked at health related quality of life, the tools used to do so are markedly heterogeneous. Future directions for the endoscopic treatment of GERD include novel techniques like endoscopic submucosal dissection.
近年来，用于治疗胃食管反流病（GERD）的内镜治疗越来越普遍。虽然腹腔镜下尼氏胃底折叠术的手术干预仍是金标准，但有两种内镜干预措施，即EsophyX和Stretta，在临床应用中越来越受到关注。EsophyX（美国华盛顿州雷德蒙德市的EndoGastric Solutions公司）是通过腔内胃底折叠术（ELF）技术来恢复胃食管交界处瓣膜功能的一种方法。长期数据表明，使用EsophyX进行经口切开胃底折叠术（TIF）在症状控制以及减少或停用质子泵抑制剂方面可能有效，长达2至6年。没有证据表明EsophyX比手术干预更有效。TIF对食管裂孔疝小于2厘米且希尔分级为I/II级瓣膜的患者可能最有效。Stretta（美国康涅狄格州格林威治市的Mederi Therapeutics公司）于2000年获得美国食品药品监督管理局批准。它将射频能量传递至食管下括约肌和胃贲门。已发表的文献综述对于Stretta在GERD管理中的推荐存在分歧。文献表明，Stretta手术具有可接受的安全性，并且在干预后长达8年的时间里可能有效减轻症状负担并改善生活质量评分。然而，客观结果似乎没有任何持续改善，也没有证据表明与手术干预相比，Stretta能带来更好的结果。作为一个领域，GERD的治疗方式在主要和次要结果方面缺乏标准化。尽管许多研究关注了与健康相关的生活质量，但用于评估的工具明显异质性。GERD内镜治疗的未来方向包括像内镜黏膜下剥离术这样的新技术。
