Calabrese Federica, Poletti Valeria, Auriemma Francesco, Paduano Danilo, Gentile Carmine, Facciorusso Antonio, Franchellucci Gianluca, De Marco Alessandro, Brandaleone Luca, Ofosu Andrew, Samanta Jayanta, Ramai Daryl, De Luca Luca, Al-Lehibi Abed, Zuliani Walter, Hassan Cesare, Repici Alessandro, Mangiavillano Benedetto
Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy.
Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy.
Diagnostics (Basel). 2023 Jun 14;13(12):2057. doi: 10.3390/diagnostics13122057.
Gastroesophageal reflux disease has a high incidence and prevalence in the general population. Clinical manifestations are heterogenous, and so is the response to medical treatment. Proton pump inhibitors are still the most common agents used to control reflux symptoms and for healing esophagitis, but they are not a one-size-fits-all solution for the disease. Patients with persistent troublesome symptoms despite medical therapy, those experiencing some adverse drug reaction, or those unwilling to take lifelong medications deserve valid alternatives. Anti-reflux Nissen fundoplication is an effective option, but the risk of adverse events has limited its spread. In recent years, advancements in therapeutic endoscopy have been made, and three major endoluminal alternatives are now available, including (1) the delivery of radiofrequency energy to the esophago-gastric junction, (2) transoral incisionless fundoplication (TIF), and (3) anti-reflux mucosal interventions (ARMI) based on mucosal resection (ARMS) and mucosal ablation (ARMA) techniques to remodel the cardia. Endoscopic techniques have shown interesting results, but their diffusion is still limited to expert endoscopists in tertiary centers. This review discusses the state of the art in the endoscopic approach to gastroesophageal reflux disease.
胃食管反流病在普通人群中的发病率和患病率都很高。其临床表现具有异质性，对药物治疗的反应也是如此。质子泵抑制剂仍然是用于控制反流症状和治愈食管炎的最常用药物，但它们并非对该疾病的通用解决方案。尽管接受了药物治疗但仍有持续困扰症状的患者、经历一些药物不良反应的患者或不愿终身服药的患者值得有有效的替代方案。抗反流尼氏胃底折叠术是一种有效的选择，但不良事件的风险限制了其推广。近年来，治疗性内镜技术取得了进展，现在有三种主要的腔内替代方案，包括：（1）向食管胃交界处输送射频能量；（2）经口无切口胃底折叠术（TIF）；（3）基于黏膜切除（ARMS）和黏膜消融（ARMA）技术重塑贲门的抗反流黏膜干预（ARMI）。内镜技术已显示出有趣的结果，但其推广仍仅限于三级中心的内镜专家。本综述讨论了胃食管反流病内镜治疗方法的现状。
