经口无切口胃底折叠术（TIF）是否是经口内镜肌切开术后胃食管反流的答案？一项多中心回顾性研究。
Is transoral incisionless fundoplication (TIF) an answer to post-peroral endoscopic myotomy gastroesophageal reflux? A multicenter retrospective study.
机构信息
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
Division of Gastroenterology, University of California Irvine, Irvine, United States.
出版信息
Endoscopy. 2022 Mar;54(3):305-309. doi: 10.1055/a-1446-8953. Epub 2021 May 28.
BACKGROUND
The use of peroral endoscopic myotomy (POEM) for achalasia has a high incidence of post-procedural gastroesophageal reflux (GER). Transoral incisionless fundoplication (TIF) may be an ideal endoscopic treatment. We report our experience with the use of post-POEM TIF.
METHODS
In this multicenter retrospective study, post-POEM patients with GER who underwent TIF were included. The study end points were: (i) technical success; (ii) safety; (iii) effectiveness (changes in symptoms, scores, proton pump inhibitor [PPI] use, pH studies).
RESULTS
12 patients underwent TIF after POEM, nine of whom had daily symptoms, with 91.7% requiring twice daily (BID) PPIs. Technical success was achieved in all patients. Two adverse events occurred. There were significant decreases in the percentage of patients on BID PPIs ( = 0.03), frequency of daily symptoms ( = 0.03), Reflux Severity Index questionnaire, and GERD Health-related Quality of Life scores ( = 0.03 and = 0.003; n = 6). pH studies performed in seven of the patients showed a significant reduction in the mean DeMeester score ( = 0.05) and mean percentage acid exposure time ( = 0.04).
CONCLUSION
Our experience suggests that TIF may be effective and safe in treating GER after POEM. Larger prospective trials are needed.
背景
经口内镜下肌切开术（POEM）治疗贲门失弛缓症后，胃食管反流（GER）的发生率较高。经口无切口胃底折叠术（TIF）可能是一种理想的内镜治疗方法。我们报告了使用 POEM 后 TIF 的经验。
方法
在这项多中心回顾性研究中，纳入了 POEM 后出现 GER 并接受 TIF 的患者。研究终点为：（i）技术成功；（ii）安全性；（iii）疗效（症状、评分、质子泵抑制剂[PPI]使用、pH 研究的变化）。
结果
12 例患者在 POEM 后接受了 TIF，其中 9 例有每日症状，91.7%需要每日两次（BID）PPI。所有患者均达到技术成功。发生了 2 起不良事件。需要 BID PPI 的患者比例（ = 0.03）、每日症状频率（ = 0.03）、反流严重程度指数问卷和 GERD 健康相关生活质量评分均显著降低（ = 0.03 和 = 0.003；n = 6）。对 7 例患者进行 pH 研究显示，平均 DeMeester 评分（ = 0.05）和平均酸暴露时间百分比（ = 0.04）显著降低。
结论
我们的经验表明，TIF 治疗 POEM 后 GER 可能是有效和安全的。需要更大的前瞻性试验。
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