Monino Laurent, Gonzalez Jean-Michel, Vitton Véronique, Barthet Marc
Department of Hepatogastroenterology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France.
Endosc Int Open. 2020 Feb;8(2):E147-E154. doi: 10.1055/a-1038-4012. Epub 2020 Jan 22.
Antireflux mucosectomy band ligation (ARM-b) is an endoscopic procedure that mimics a fundoplication for managing gastroesophoageal reflux disease (GERD). The aim of this study was to assess safety and feasibility of ARM-b. This was a single-center study on consecutive patients operated between June 2017 and January 2019 with refractory GERD, confirmed with pH-metry and without motility disorder at high-resolution manometry. A piecemeal mucosectomy of three quarters of circumference of esophagogastric junction was performed using a band ligation system and a hexagonal snare. The primary objective was to assess procedural safety and feasibility. The secondary objective was to document the clinical improvement at 3 and 6 months based on patient satisfaction, proton pump inhibitor (PPI) intake, symptoms, and quality of life scores. Twenty-onepatients (11 men) with mean age 56.9 ± 14.4 years were analyzed. The technical success rate was 100 % (mean duration 35 ± 11 min). Four patients (19 %) had mild adverse events: one delayed bleeding at Day 1 managed conservatively, and three dysphagia endoscopically managed. Mean follow-up was 10 ± 5 months. Decrease/discontinuation of PPI intake was 76 % at 3 months and 72 % at 6 months. Improvement in mean symptoms and quality of life scores (GERD-Q and GERD-HQL) were statistically significant. One patient required laparoscopic fundoplication after ARM-b failure without complication. ARM-b is safe, feasible, and symptom-effective for treating refractory GERD, and it can be performed in the ambulatory setting. Further prospective studies are required to confirm these promising outcomes.
抗反流黏膜切除术联合套扎术（ARM-b）是一种内镜手术，可模拟胃底折叠术来治疗胃食管反流病（GERD）。本研究旨在评估ARM-b的安全性和可行性。这是一项单中心研究，纳入了2017年6月至2019年1月间连续接受手术治疗的难治性GERD患者，通过pH测定法确诊，高分辨率测压法未发现动力障碍。使用套扎系统和六边形圈套器对食管胃交界部四分之三周长进行分步黏膜切除术。主要目的是评估手术的安全性和可行性。次要目的是根据患者满意度、质子泵抑制剂（PPI）摄入量、症状及生活质量评分记录3个月和6个月时的临床改善情况。分析了21例患者（11例男性），平均年龄56.9±14.4岁。技术成功率为100%（平均持续时间35±11分钟）。4例患者（19%）出现轻度不良事件：1例术后第1天出现延迟出血，保守治疗；3例吞咽困难，经内镜治疗。平均随访时间为10±5个月。3个月时PPI摄入量减少/停用率为76%，6个月时为72%。平均症状和生活质量评分（GERD-Q和GERD-HQL）改善具有统计学意义。1例患者在ARM-b失败后接受腹腔镜胃底折叠术，无并发症。ARM-b治疗难治性GERD安全、可行且症状有效，可在门诊进行。需要进一步的前瞻性研究来证实这些有前景的结果。
