O'Connor K W, Lehman G A
Division of Gastroenterology, Indiana University School of Medicine, Indianapolis.
Gastrointest Endosc. 1988 Mar-Apr;34(2):106-12. doi: 10.1016/s0016-5107(88)71273-0.
Ten highly symptomatic and medically refractory refluxing patients were treated with a new endoscopic technique to decrease gastroesophageal reflux. Cross-linked bovine dermal collagen was injected beneath the mucosa in the area of the lower esophageal sphincter through a 23 gauge needle-tipped catheter. A mean volume of 85 ml of implant was injected in 0.5- to 4-ml increments over 3 to 10 injection sessions. All patients developed objective evidence of decreased reflux by one or more parameters. Nine out of 10 patients had decreased symptoms, and 8 of 9 patients had an increase in lower esophageal pressure after implant injection. Endoscopic implant treatment resulted in statistically significant improvement in symptom scores (p less than 0.001), the standard acid reflux test (p = 0.009), and lower esophageal sphincter pressures (p = 0.002), but not in the endoscopic appearance of the esophagus (p = 0.131). Subjective and objective improvements in reflux parameters generally lasted 6 to 9 months with return toward pretreatment status by 12 months. Antibodies to bovine collagen developed in 5 of 10 subjects with no clinical sequelae and no apparent reactivity with human collagen. The technique is not difficult to perform and is well tolerated by patients, and the results indicate the potential for more general use with a more suitable implant material.
十名症状严重且药物治疗无效的反流患者接受了一种新的内镜技术治疗，以减少胃食管反流。通过一根23号针尖导管，将交联牛真皮胶原蛋白注射到食管下括约肌区域的黏膜下。在3至10次注射过程中，以0.5至4毫升的增量平均注射85毫升植入物。所有患者均通过一个或多个参数出现反流减少的客观证据。10名患者中有9名症状减轻，9名患者中有8名在植入物注射后食管下压力增加。内镜植入治疗在症状评分（p<0.001）、标准酸反流试验（p=0.009）和食管下括约肌压力（p=0.002）方面有统计学显著改善，但在食管的内镜表现方面无改善（p=0.131）。反流参数的主观和客观改善通常持续6至9个月，到12个月时恢复到治疗前状态。10名受试者中有5名产生了针对牛胶原蛋白的抗体，无临床后遗症，且与人胶原蛋白无明显反应。该技术操作不难，患者耐受性良好，结果表明使用更合适的植入材料有更广泛应用的潜力。
