Bjelović Miloš, Harsányi László, Altorjay Áron, Kincses Zsolt, Forsell Peter
Department for Minimally Invasive Upper Digestive Surgery, University Hospital for Digestive Surgery - First Surgical Hospital, Clinical Center of Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia.
1st Department of Surgery, Semmelweis University, Budapest, Hungary.
BMC Surg. 2020 Jul 20;20(1):159. doi: 10.1186/s12893-020-00794-9.
RefluxStop™ is an implantable, non-active, single use device used in the laparoscopic treatment of GERD. RefluxStop™ aims to block the movement of the LES up into the thorax and keep the angle of His in its original, anatomically correct position. This new device restores normal anatomy, leaving the food passageway unaffected.
In a prospective, single arm, multicentric clinical investigation analyzing safety and effectiveness of the RefluxStop™ device to treat GERD, 50 subjects with chronic GERD were operated using a standardized surgical technique between December 2016 and September 2017. They were followed up for 1 year (CE-mark investigation 6-months). Primary safety outcome was prevalence of serious adverse events related to the device, and primary effectiveness outcome reduction of GERD symptoms based on GERD-HRQL score. Secondary outcomes were prevalence of adverse events other than serious adverse events, reduction of total acid exposure time in 24-h pH monitoring, and reduction in average daily PPI usage and subject satisfaction.
There were no serious adverse events related to the device. Average GERD-HRQL total score at 1 year improved 86% from baseline (p < 0.001). 24-h pH monitoring compared to baseline showed a mean reduction percentage of overall time with pH < 4 from 16.35 to 0.80% at the 6-month visit (p < 0.001), with 98% of subjects showing normal 24-h pH. At 1 year: No new cases of dysphagia were recorded, present in 2 subjects, which existed already at baseline. Regular daily PPI usage occurred in all 50 subjects at baseline. At 1-year follow-up, only 1 subject took regular daily PPIs due to a too low placement of the device thereby prohibiting its function. None or minimal occasional episodes of regurgitation occurred in 97.8% of evaluable subjects. Gas bloating disappeared in 30 subjects and improved in 7 subjects.
The new principle of RefluxStop™ is safe and effective to treat GERD according to investigation results. At 1-year follow-up, both the GERD-HRQL score and 24-h pH monitoring results indicate success for the new treatment principle. In addition, with the dynamic treatment for acid reflux, which avoids compressing the food passageway, prevalence of dysphagia and gas bloating are significantly reduced.
ClinicalTrials.gov , NCT02759094 . Registered 3 May, 2016.
RefluxStop™是一种可植入的、非活性的一次性装置,用于腹腔镜治疗胃食管反流病(GERD)。RefluxStop™旨在阻止食管下括约肌(LES)向上移入胸腔,并使希氏角保持在其原始的、解剖学上正确的位置。这种新装置可恢复正常解剖结构,而不影响食物通道。
在一项前瞻性、单臂、多中心临床研究中,分析RefluxStop™装置治疗GERD的安全性和有效性,2016年12月至2017年9月期间,使用标准化手术技术对50例慢性GERD患者进行手术。对他们进行了1年的随访(CE标志调查为6个月)。主要安全结局是与该装置相关的严重不良事件的发生率,主要有效性结局是基于GERD-HRQL评分的GERD症状减轻。次要结局是除严重不良事件外的不良事件发生率、24小时pH监测中总酸暴露时间的减少、每日平均质子泵抑制剂(PPI)使用量的减少以及患者满意度。
未发生与该装置相关的严重不良事件。1年时GERD-HRQL总分平均较基线改善86%(p<0.001)。与基线相比,24小时pH监测显示,在6个月随访时,pH<4的总时间平均减少百分比从16.35%降至0.80%(p<0.001),98%的患者24小时pH值正常。1年时:未记录到新的吞咽困难病例,2例患者存在吞咽困难,这在基线时就已存在。所有50例患者在基线时均规律每日使用PPI。在1年随访时,仅1例患者因装置放置过低而无法发挥功能,仍规律每日使用PPI。97.8%的可评估患者未发生反流或仅有极少的偶发反流事件。30例患者腹胀消失,7例患者腹胀改善。
根据研究结果,RefluxStop™的新原理治疗GERD安全有效。在1年随访时,GERD-HRQL评分和24小时pH监测结果均表明新治疗原理取得成功。此外,通过对胃酸反流的动态治疗,避免了对食物通道的压迫,吞咽困难和腹胀的发生率显著降低。
ClinicalTrials.gov,NCT02759094。2016年5月3日注册。