Division of Gastroenterology, Department of Internal Medicine, Cha Gangnam Medical Center, College of Medicine, Cha University, 566, Nonhyeon-Ro, Gangnam-Gu, Seoul, Republic of Korea.
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Surg Endosc. 2024 Aug;38(8):4278-4286. doi: 10.1007/s00464-024-10947-z. Epub 2024 Jun 12.
Treatment options for gastroesophageal reflux disease (GERD) that is unresponsive to proton pump inhibitors (PPIs) remain limited. Therefore, we compared the therapeutic effects of anti-reflux mucosectomy (ARMS) and Stretta radiofrequency (SRF) for intractable GERD in over 400 individuals who underwent either procedure.
We conducted a retrospective study between 2016 and 2023 to evaluate the effectiveness of SRF and ARMS treatments for refractory GERD. The primary measure of success was the change in the GERD questionnaire (GERDQ) score. The secondary outcomes were various GERD-related indicators, including endoscopic Los Angeles (LA) classification, Hill's type-based flap valve grade (FVG), EndoFLIP™ distensibility index (DI), rate of PPI discontinuation, resolution rate of Barrett's esophagus, and incidence of adverse events.
The ARMS group included patients with high GERDQ scores, FVG, LA grade, and Barrett's esophagus. Both groups had similar rates of improvements in GERDQ score (P = 0.884) and PPI withdrawal (P = 0.866); however, the ARMS group had significantly more side effects and improvements in the median change in GERDQ score (P = 0.011), FVG (P < 0.001), LA grade (P < 0.001), EndoFLIP™ DI (P < 0.001), and resolution of Barrett's esophagus (P < 0.001).
The ARMS group had a greater GERDQ score improvement than the SRF group but had symptom relief and PPI discontinuation rates similar to those of the SRF group. However, objective measures, including EndoFLIP™ DI and endoscopic evaluations, were better in the ARMS group than in the SRF group.
质子泵抑制剂（PPIs）治疗无效的胃食管反流病（GERD）的治疗选择仍然有限。因此，我们比较了超过 400 名接受抗反流黏膜切除术（ARMS）或 Stretta 射频（SRF）治疗的难治性 GERD 患者的治疗效果。
我们进行了一项回顾性研究，评估了 2016 年至 2023 年期间 SRF 和 ARMS 治疗难治性 GERD 的效果。主要成功衡量标准是 GERD 问卷（GERDQ）评分的变化。次要结果包括各种与 GERD 相关的指标，包括内镜洛杉矶（LA）分类、基于 Hill 类型的瓣阀等级（FVG）、EndoFLIP™可扩张性指数（DI）、PPI 停药率、Barrett 食管的缓解率和不良事件的发生率。
ARMS 组患者的 GERDQ 评分高、FVG、LA 分级和 Barrett 食管。两组在 GERDQ 评分改善率（P=0.884）和 PPI 停药率（P=0.866）方面相似，但 ARMS 组的不良反应和 GERDQ 评分（P=0.011）、FVG（P<0.001）、LA 分级（P<0.001）、EndoFLIP™ DI（P<0.001）和 Barrett 食管缓解率（P<0.001）的中位数变化明显更高。
ARMS 组的 GERDQ 评分改善程度大于 SRF 组，但症状缓解率和 PPI 停药率与 SRF 组相似。然而，ARMS 组的客观指标，包括 EndoFLIP™ DI 和内镜评估，均优于 SRF 组。
