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客观证据显示磁括约肌增强后可控制反流:一项上市后研究一年结果。

Objective Evidence of Reflux Control After Magnetic Sphincter Augmentation: One Year Results From a Post Approval Study.

机构信息

Division of Thoracic Surgery, Swedish Medical Center, Seattle, WA.

Esophageal Institute of Atlanta, Atlanta, GA.

出版信息

Ann Surg. 2019 Aug;270(2):302-308. doi: 10.1097/SLA.0000000000002789.

Abstract

OBJECTIVE

To report 1-year results from a 5-year mandated study.

SUMMARY BACKGROUND DATA

In 2012, the United States Food and Drug Administration approved magnetic sphincter augmentation (MSA) with the LINX Reflux Management System (Torax Medical, Shoreview, MN), a novel device for the surgical treatment of gastroesophageal reflux disease (GERD). Continued assessment of safety and effectiveness has been monitored in a Post Approval Study.

METHODS

Multicenter, prospective study of patients with pathologic acid reflux confirmed by esophageal pH testing undergoing MSA. Predefined clinical outcomes were assessed at the annual visit including a validated, disease-specific questionnaire, esophagogastricduodenoscopy and esophageal pH monitoring, and use of proton pump inhibitors.

RESULTS

A total of 200 patients (102 males, 98 females) with a mean age of 48.5 years (range 19.7-71.6) were treated with MSA between March 2013 and August 2015. At 1 year, the mean total acid exposure time decreased from 10.0% at baseline to 3.6%, and 74.4% of patients had normal esophageal acid exposure time (% time pH<4 ≤5.3%). GERD Health-Related Quality of Life scores improved from a median score of 26.0 at baseline to 4.0 at 1 year, with 84% of patients meeting the predefined success criteria of at least a 50% reduction in total GERD Health-Related Quality of Life score compared with baseline. The device removal rate at 1 year was 2.5%. One erosion and no serious adverse events were reported.

CONCLUSIONS

Safety and effectiveness of magnetic sphincter augmentation has been demonstrated outside of an investigational setting to further confirm MSA as treatment for GERD.

摘要

目的

报告一项为期 5 年的强制研究的 1 年结果。

摘要背景数据

2012 年,美国食品和药物管理局批准了磁括约肌增强术(MSA)联合 LINX 反流管理系统(Torax Medical,Shoreview,MN)用于治疗胃食管反流病(GERD),这是一种新型的手术治疗方法。在批准后研究中,继续监测安全性和有效性的评估。

方法

对经食管 pH 测试证实存在病理性酸反流的患者进行多中心前瞻性 MSA 研究。在年度就诊时评估预先确定的临床结局,包括经过验证的、特定于疾病的问卷、食管胃十二指肠镜检查和食管 pH 监测以及质子泵抑制剂的使用。

结果

2013 年 3 月至 2015 年 8 月期间,共有 200 例(102 例男性,98 例女性)平均年龄为 48.5 岁(19.7-71.6 岁)的患者接受了 MSA 治疗。1 年后,平均总酸暴露时间从基线时的 10.0%降至 3.6%,74.4%的患者食管酸暴露时间正常(%时间 pH<4 ≤5.3%)。GERD 健康相关生活质量评分从基线时的中位数 26.0 分改善至 1 年时的 4.0 分,84%的患者达到了至少 50%的总 GERD 健康相关生活质量评分与基线相比降低的预定成功标准。1 年后设备移除率为 2.5%。报告了 1 例溃疡和无严重不良事件。

结论

在非研究环境下进一步证实了磁括约肌增强术的安全性和有效性,将 MSA 作为 GERD 的治疗方法。

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