Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
Department of Internal Medicine, Katsuragi Hospital, Kishiwada, Osaka, Japan.
BMC Gastroenterol. 2021 Nov 18;21(1):432. doi: 10.1186/s12876-021-02022-x.
Although some kinds of endoluminal surgery for patients with proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) have been reported, there are few reports on their long-term outcomes. In 2014, we reported the effectiveness of endoscopic surgery for PPI-refractory GERD, which we invented and named endoscopic submucosal dissection for GERD (ESD-G) in 2008. Thereafter, we accumulated more cases and monitored the patients' condition postoperatively and describe the outcomes herein.
This single-center, single-arm trial was conducted at the Osaka Medical and Pharmaceutical University Hospital. We compared outcomes between before and 3-6 months after ESD-G. Additionally, we investigated the outcomes of patients 5 or more years after ESD-G.
We performed 42 ESD-G procedures in 35 patients between 2008 and 2020. In seven patients, ESD-G was performed twice for various reasons. The frequency scale for the symptoms of GERD score was significantly improved 3-6 months after ESD-G (22 → 10, p < 0.0001); the Los Angeles classification for reflux esophagitis was clearly improved after ESD-G (p = 0.0423). The number of reflux episodes was not decreased by ESD-G. There was a significant difference in the potency unit of gastric acid secretion suppressants for controlling GERD-related symptoms between baseline and 3-6 months after ESD-G (p = 0.0009). In patients without a history of distal gastrectomy who underwent ESD-G, the potency unit of gastric acid secretion suppressants significantly decreased 5 or more years after ESD-G (p = 0.0121).
ESD-G may be effective in patients with refractory GERD-related symptoms without a history of distal gastrectomy.
尽管已经报道了一些质子泵抑制剂（PPI）难治性胃食管反流病（GERD）的内镜下手术治疗方法，但关于其长期疗效的报道较少。2014 年，我们报道了我们发明的内镜下黏膜下剥离术（ESD-G）治疗 PPI 难治性 GERD 的有效性，该术式于 2008 年命名。此后，我们积累了更多的病例，并对术后患者的病情进行了监测，现将结果报告如下。
这项单中心、单臂试验在大阪医科药科大学医院进行。我们比较了 ESD-G 前后 3-6 个月的结果。此外，我们还调查了 ESD-G 5 年以上患者的结果。
我们在 2008 年至 2020 年间对 35 例患者进行了 42 次 ESD-G 手术。有 7 例患者因各种原因进行了 2 次 ESD-G。ESD-G 后 3-6 个月，GERD 症状严重程度评分（频率量表）显著改善（22→10，p<0.0001）；反流性食管炎洛杉矶分级明显改善（p=0.0423）。ESD-G 并未减少反流次数。ESD-G 前后，控制 GERD 相关症状的胃酸分泌抑制剂的药效单位存在显著差异（p=0.0009）。在未行远端胃切除术的 ESD-G 患者中，ESD-G 5 年以上后胃酸分泌抑制剂的药效单位显著降低（p=0.0121）。
ESD-G 可能对无远端胃切除术史的难治性 GERD 相关症状患者有效。
