Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid 28034, Spain.
Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra. Gastrointestinal Endoscopy Research Unit, Navarrabiomed Biomedical Research Center. Pamplona, Spain.
World J Gastroenterol. 2021 Oct 21;27(39):6601-6614. doi: 10.3748/wjg.v27.i39.6601.
Gastroesophageal reflux disease has an increasing incidence and prevalence worldwide. A significant proportion of patients have a suboptimal response to proton pump inhibitors or are unwilling to take lifelong medication due to concerns about long-term adverse effects. Endoscopic anti-reflux therapies offer a minimally invasive option for patients unwilling to undergo surgical treatment or take lifelong medication. The best candidates are those with a good response to proton pump inhibitors and without a significant sliding hiatal hernia. Transoral incisionless fundoplication and nonablative radiofrequency are the techniques with the largest body of evidence and that have been tested in several randomized clinical trials. Band-assisted ligation techniques, anti-reflux mucosectomy, anti-reflux mucosal ablation, and new plication devices have yielded promising results in recent noncontrolled studies. Nonetheless, the role of endoscopic procedures remains controversial due to limited long-term and comparative data, and no consensus exists in current clinical guidelines. This review provides an updated summary focused on the patient selection, technical details, clinical success, and safety of current and future endoscopic anti-reflux techniques.
胃食管反流病在全球的发病率和患病率呈上升趋势。相当一部分患者对质子泵抑制剂的反应不佳，或由于担心长期不良反应而不愿意长期服药。对于不愿意接受手术治疗或长期服药的患者，内镜抗反流治疗提供了一种微创选择。最佳人选是那些对质子泵抑制剂反应良好且无明显滑动性食管裂孔疝的患者。经口无切口胃底折叠术和非消融性射频是证据最多、已在多项随机临床试验中得到验证的技术。带辅助结扎技术、抗反流黏膜切除术、抗反流黏膜消融术和新型折叠装置在最近的非对照研究中取得了有希望的结果。尽管如此，由于缺乏长期和比较数据，内镜治疗的作用仍存在争议，目前的临床指南也没有达成共识。本综述提供了一个更新的总结，重点关注当前和未来内镜抗反流技术的患者选择、技术细节、临床成功率和安全性。
