Department of Surgery, Sanatorio Argentino of San Juan, San Juan.
Department of Surgery, Hospital Alemán of Buenos Aires.
J Clin Gastroenterol. 2024 Oct 1;58(9):851-856. doi: 10.1097/MCG.0000000000002061.
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders in western countries. Endoscopic procedures have recently emerged as an alternative therapy to surgery for patients with GERD. The aim of this study was to determine outcomes after endoscopic antireflux mucosectomy (ARMS).
A systematic review and meta-analysis were performed to analyze outcomes after ARMS. The main outcomes included patients' satisfaction, GERD health-related quality of life, use of proton pump inhibitors, and DeMeester score. The secondary endpoint was postprocedural adverse events. A meta-analysis of proportions was used to assess the effect of each approach on different outcomes.
A total of 22 studies comprising 654 patients were included for analysis. The mean age of patients was 51.83 (36 to 59.39) years, and the mean body mass index was 25.06 (23.5 to 27) kg/m 2 . The weighted pooled proportion of patient satisfaction after ARMS was 65% (95% CI: 52%-76%). The pooled proportion of patients taking proton pump inhibitors decreases from 100% to 40.84% ( P < 0.001). The mean GERD health-related quality of life scores (pre 19.48 vs post 7.90, P < 0.001) and DeMeester score (pre 44.99 vs post 15.02 P = 0.005) significantly improved after ARMS. Overall morbidity rate was 27% (95% CI: 13%-47%), with a weighted pooled proportion of perforation, stricture, and bleeding of 3% (95% CI: 2%-6%), 12% (95% CI: 9%-16%), and 6% (95% CI: 2%-17%), respectively.
Endoscopic ARMS for GERD is associated with symptomatic improvement, reduction of medical therapy, and enhanced quality of life. Refinements of the technique, however, are needed to decrease morbidity.
胃食管反流病（GERD）是西方国家最常见的胃肠道疾病之一。内镜下治疗最近已成为 GERD 患者手术治疗的替代方法。本研究旨在确定内镜抗反流黏膜切除术（ARMS）后的结果。
对 ARMS 后结果进行系统回顾和荟萃分析。主要结果包括患者满意度、GERD 健康相关生活质量、质子泵抑制剂的使用和 DeMeester 评分。次要终点是术后不良事件。使用比例的荟萃分析评估每种方法对不同结果的影响。
共纳入 22 项研究，共 654 例患者进行分析。患者的平均年龄为 51.83（36 至 59.39）岁，平均体重指数为 25.06（23.5 至 27）kg/m 2 。ARMS 后患者满意度的加权汇总比例为 65%（95%CI：52%-76%）。服用质子泵抑制剂的患者比例从 100%下降到 40.84%（P<0.001）。GERD 健康相关生活质量评分（术前 19.48 分，术后 7.90 分，P<0.001）和 DeMeester 评分（术前 44.99 分，术后 15.02 分，P=0.005）在 ARMS 后显著改善。总体发病率为 27%（95%CI：13%-47%），穿孔、狭窄和出血的加权汇总比例分别为 3%（95%CI：2%-6%）、12%（95%CI：9%-16%）和 6%（95%CI：2%-17%）。
内镜下 ARMS 治疗 GERD 与症状改善、减少药物治疗和提高生活质量有关。然而，需要改进技术以降低发病率。
