Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
Surg Endosc. 2019 Nov;33(11):3623-3628. doi: 10.1007/s00464-018-06649-y. Epub 2019 Jan 22.
Laparoscopic fundoplication (LF), even if performed in specialized centers, can be followed by long-term side effects such as dysphagia, gas bloating or inability to belch. Patients with an ineffective esophageal motility (IEM) and concurrent GERD are prone to postoperative dysphagia after LF. The aim of this study is to evaluate the safety and efficacy of electrical lower esophageal sphincter stimulation in patients with IEM and GERD.
This is a prospective, open-label single center study. Patients with PPI-refractory GERD and ineffective esophageal motility were included for lower esophageal sphincter electrical stimulation (LES-EST). Patients underwent prospective follow-up including physical examination, interrogation of the device and were surveyed for changes in the health-related quality of life score.
According to power analysis, 17 patients were included in this study. Median distal contractile integral (DCI) was 64 mmHg s cm (quartiles 11.5-301). Median total % pH < 4 was 8.9 (quartiles 4-21.6). Twelve patients (70.6%) underwent additional hiatal repair. At 1-month follow-up, none of the patients showed any clinical or radiological signs of dysphagia. There were no procedure related severe adverse events. Mean total HQRL improved from baseline 37.53 (SD 15.07) to 10.93 (SD 9.18) at follow-up (FUP) (mean difference 24.0 CI 15.93-32.07) p < 0.001.
LES-EST was introduced as a potential technique to avoid side effects of LF. LES-EST significantly improved health related quality of life and does not impair swallowing in patients with GERD and ineffective esophageal motility.
腹腔镜胃底折叠术（LF），即使在专业中心进行，也可能会出现长期的副作用，如吞咽困难、胀气或呃逆困难。食管动力障碍（IEM）和并发 GERD 的患者在 LF 后容易出现术后吞咽困难。本研究旨在评估 IEM 和 GERD 患者食管下括约肌电刺激（LES-EST）的安全性和有效性。
这是一项前瞻性、开放标签的单中心研究。纳入了 PPI 难治性 GERD 和无效食管动力的患者进行食管下括约肌电刺激（LES-EST）。患者进行了前瞻性随访，包括体格检查、设备询问，并对健康相关生活质量评分的变化进行了调查。
根据功率分析，本研究纳入了 17 名患者。中位远端收缩积分（DCI）为 64mmHg·s·cm（四分位距 11.5-301）。中位总 pH < 4 的百分比为 8.9（四分位距 4-21.6）。12 名患者（70.6%）接受了额外的食管裂孔修复。在 1 个月的随访中，没有患者出现任何临床或放射学吞咽困难的迹象。没有与手术相关的严重不良事件。总 HQRL 从基线的 37.53（SD 15.07）改善至随访时的 10.93（SD 9.18）（平均差值 24.0，CI 15.93-32.07，p < 0.001）。
LES-EST 作为一种避免 LF 副作用的潜在技术被引入。LES-EST 显著改善了 GERD 和无效食管动力患者的健康相关生活质量，且不影响吞咽。
