Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Department of Surgery, National Hospital Organization Nishisaitama-Chuo National Hospital, 2-1671 Wakasa, Tokorozawa, 359-1151, Japan.
Esophagus. 2021 Oct;18(4):915-921. doi: 10.1007/s10388-021-00843-z. Epub 2021 Apr 23.
The Lyon Consensus was conducted in 2017, leading to a revision of the diagnostic criteria of GERD. Conclusive GERD was defined as cases in which the distal esophageal acid exposure time (AET) is greater than 6% and there exists either peptic esophagitis, constriction, or long-segment Barrett's mucosa with a Los Angeles classification of grade C or D. Borderline GERD is defined as cases in which AET is between 4 and 6% and there exists peptic esophagitis with a Los Angeles classification of either grade A or B. All other cases were defined as Inconclusive GERD. We conducted a retrospective investigation of the treatment results of laparoscopic fundoplication (LF) for GERD according to the Lyon Consensus and evaluated whether or not it is an effective treatment predictor.
From among the cases of primary LF conducted on patients with GERD-related illnesses at our university hospital from June 2008 to March 2020, the subjects included 215 individuals who underwent upper gastrointestinal endoscopy and 24 h multichannel intraluminal impedance pH (MII-pH) testing prior to surgery. We compared the pathophysiology of the Conclusive GERD Group (Group A), Borderline GERD Group (Group B), and Inconclusive GERD Group (Group C), and then investigated the treatment results of each group. We used AFP classification for pathophysiological evaluation. For the acid reflux evaluation, we conducted MII-pH measurements using Sleuth, manufactured by Sandhill. The postoperative evaluation period was set to 3 months following surgery. The data are expressed using median values, with a statistical significance defined as p < 0.05 using the Kruskal-Wallis, Mann-Whitney, Wilcoxon signed-rank, and Chi-squared tests.
Group A: 92 cases (43%, male 69 cases, age 57), Group B: 48 cases (22%, male 20 cases, age 52), and Group C: 75 cases (35%, male 69 cases, age 57). Regarding the patient backgrounds, while there were no significant differences in terms of gender or disease duration, those in Group A were significantly older than the other two groups, and there was a significant difference in Body Mass Index (BMI) between Group A and Group C. The results of each factor were: A factor (1 vs.1 vs. 1, p < 0.001), F factor (2 vs. 0 vs. 0, p < 0.001), and P factor (2 vs. 1 vs. 0, p < 0.001), with AET of 10.0 vs. 2.9 vs. 0.6, p < 0.001, and the disease had progressed more in Group A. There were also no differences in terms of surgical methods, hemorrhage volume, and intraoperative/postoperative complications; however, the use of mesh was higher and surgery duration was longer in Group A. There were obvious improvements in the A, F, and P factors and AET of each group following surgery (other than F and P of Group C, p < 0.001). The rate of recurrence was 15% in Group A, 8% in Group B, and 6% in Group C. It tended to be higher in Group A, but this was not statistically significant.
The classification of GERD pathophysiology based on the Lyon Consensus is satisfactory, with no significant differences in the rate of effect of LF. The Lyon Consensus is effective for ascertaining the severity and pathophysiology of GERD; however, we were unable to forecast the treatment results of LF.
2017 年召开了里昂共识会议，对 GERD 的诊断标准进行了修订。明确的 GERD 定义为远端食管酸暴露时间（AET）大于 6%，且存在消化性食管炎、狭窄或洛杉矶分类为 C 或 D 级的长节段 Barrett 黏膜的病例。临界 GERD 定义为 AET 在 4%至 6%之间且存在洛杉矶分类为 A 或 B 级的消化性食管炎的病例。所有其他病例均定义为不确定的 GERD。我们根据里昂共识对腹腔镜胃底折叠术（LF）治疗 GERD 的治疗结果进行了回顾性研究，并评估了它是否是一种有效的治疗预测指标。
从我们大学医院 2008 年 6 月至 2020 年 3 月对 GERD 相关疾病患者进行的原发性 LF 病例中，选择了 215 名接受上消化道内镜检查和 24 小时多通道腔内阻抗 pH（MII-pH）检测的患者作为研究对象。我们比较了明确 GERD 组（A 组）、临界 GERD 组（B 组）和不确定 GERD 组（C 组）的病理生理学，并研究了每组的治疗结果。我们使用 AFP 分类进行病理生理学评估。对于酸反流评估，我们使用 Sandhill 制造的 Sleuth 进行 MII-pH 测量。术后评估期设定为手术后 3 个月。数据以中位数表示，使用 Kruskal-Wallis、Mann-Whitney、Wilcoxon 符号秩和和卡方检验，以 p<0.05 为统计学显著差异。
A 组：92 例（43%，男性 69 例，年龄 57 岁），B 组：48 例（22%，男性 20 例，年龄 52 岁），C 组：75 例（35%，男性 69 例，年龄 57 岁）。在患者背景方面，虽然在性别或疾病持续时间方面没有差异，但 A 组的年龄明显大于其他两组，A 组和 C 组的体重指数（BMI）存在显著差异。每个因素的结果为：A 因素（1 比 1 比 1，p<0.001），F 因素（2 比 0 比 0，p<0.001）和 P 因素（2 比 1 比 0，p<0.001），AET 为 10.0 比 2.9 比 0.6，p<0.001，A 组的疾病进展更严重。手术方法、出血量和术中/术后并发症方面也没有差异；然而，A 组的网状物使用率更高，手术时间更长。每组的 A、F 和 P 因素以及 AET 在手术后均有明显改善（C 组的 F 和 P 除外，p<0.001）。A 组的复发率为 15%，B 组为 8%，C 组为 6%。A 组的复发率较高，但无统计学意义。
基于里昂共识的 GERD 病理生理学分类是令人满意的，LF 效果的发生率没有差异。里昂共识可有效确定 GERD 的严重程度和病理生理学；然而，我们无法预测 LF 的治疗结果。
