Testoni Sabrina, Hassan Cesare, Mazzoleni Giorgia, Antonelli Giulio, Fanti Lorella, Passaretti Sandro, Correale Loredana, Cavestro Giulia Martina, Testoni Pier Alberto
Division of Pancreatico-Biliary Endoscopy & Endosonography, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy.
Ospedale Nuovo Regina Margherita, Digestive Endoscopy Unit, Rome, Italy.
Endosc Int Open. 2021 Feb;9(2):E239-E246. doi: 10.1055/a-1322-2209. Epub 2021 Feb 3.
Few reports exist about long-term outcomes of transoral incisionless fundoplication (TIF) for treating refractory gastro-esophageal reflux disease (GERD). A literature search of four major scientific databases was performed up to May 2020 for studies reporting on more than 3-year outcomes of TIF. Data on atient satisfaction, proton pump inhibitor (PPI) daily consumption, PPI use reduction, GERD health-related quality-of-life (GERD-HRQL) score, and normalization of heartburn and regurgitation scores were pooled and summarized with forest plots. Publication bias and heterogeneity were explored. Overall, eight studies (418 patients, 232 men; 55.5 %) with a mean follow-up of 5.3 years (range: 3-10 years) were included. The pooled proportion of patient-reported satisfaction before and after TIF was 12.3 % (95 % CI:12.3-35.1 %, I = 87.4 %) and 70.6 % (95 % CI:51.2-84.6, I = 80 %), respectively, corresponding to an odds ratio of 21.4 (95 % CI:3.27-140.5). Pooled rates of patients completely off PPIs and on occasional PPIs were 53.8 % (95 %CI: 42.0 %-65.1 %) and 75.8 % (95 %CI: 67.6-82.6), respectively. The pooled estimated mean GERD-HRQL scores off PPI before and after TIF werey 26.1 (95 %CI: 21.5-30.7; range: 20.0-35.5) and 5.9, respectively (95 %CI:0.35.1-11.4; range: 5.3-9.8; < 0.001). The overall pooled rates of heartburn and regurgitation scores normalization were 73.0 % (95 %CI: 0.62-0.82) and 86 %, respectively (95 %CI: 75.0-91.0 %). Our study shows that TIF appears to offer a long-term safe therapeutic option for selected patients with GERD who refuse life-long medical therapy or surgery, are intolerant to PPIs, or are at increased surgical risk.
关于经口无切口胃底折叠术（TIF）治疗难治性胃食管反流病（GERD）的长期疗效，相关报道较少。截至2020年5月，我们在四个主要科学数据库中进行了文献检索，以查找报告TIF超过3年疗效的研究。汇总并通过森林图总结了患者满意度、质子泵抑制剂（PPI）每日消耗量、PPI使用减少情况、GERD健康相关生活质量（GERD-HRQL）评分以及烧心和反流评分正常化的数据。探讨了发表偏倚和异质性。总体而言，纳入了八项研究（418例患者，232例男性；占55.5%），平均随访5.3年（范围：3至10年）。TIF前后患者报告的满意度合并比例分别为12.3%（95%CI：12.3 - 35.1%，I² = 87.4%）和70.6%（95%CI：51.2 - 84.6，I² = 80%），对应比值比为21.4（95%CI：3.27 - 140.5）。完全停用PPI和偶尔使用PPI的患者合并比例分别为53.8%（95%CI：42.0% - 65.1%）和75.8%（95%CI：67.6 - 82.6）。TIF前后停用PPI时GERD-HRQL评分的合并估计均值分别为26.1（95%CI：21.5 - 30.7；范围：20.0 - 35.5）和5.9（95%CI：0.35.1 - 11.4；范围：5.3 - 9.8；P < 0.001）。烧心和反流评分正常化的总体合并率分别为73.0%（95%CI：0.62 - 0.82）和86%（95%CI：75.0 - 91.0%）。我们的研究表明，对于那些拒绝终身药物治疗或手术、对PPI不耐受或手术风险增加的特定GERD患者，TIF似乎提供了一种长期安全的治疗选择。
