Angeramo Cristian A, Lendoire Mateo, Herbella Fernando A M, Schlottmann Francisco
Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
Department of Surgery, Escola Paulista de Medicina, São Paulo, Brazil.
Gastrointest Endosc. 2025 Jul;102(1):14-25.e1. doi: 10.1016/j.gie.2024.12.026. Epub 2024 Dec 21.
GERD affects 10% to 30% of the population. Endoscopic antireflux therapies have been proposed for carefully selected patients. In this study, we compared outcomes between endoscopic antireflux mucosectomy (ARMS) and endoscopic radiofrequency ablation of the lower esophageal sphincter (Stretta procedure) for the treatment of GERD.
A systematic review using the MEDLINE database was performed to identify original articles analyzing outcomes after ARMS and Stretta procedures. The main outcomes were patient satisfaction, GERD Health-Related Quality of Life (GERD-HRQL) scores, proton pump inhibitor (PPI) use, and DeMeester scores. Secondary outcomes were postprocedural adverse events. A meta-analysis of proportions and linear regression models was used to assess the effect of each endoscopic procedure on the different outcomes.
Sixty-six studies comprising 3767 patients were included, with 3074 patients (81.60%) undergoing Stretta and 693 (18.40%) ARMS. The weighted pooled patient satisfaction rates were 65% (95% confidence interval [CI], 52-76) for ARMS and 77% (95% CI, 64-87) for Stretta. Both treatments significantly reduced PPI use (from 100% to 40.18% for ARMS vs from 99.42% to 48.51% for Stretta, P = .20) and improved GERD-HRQL scores (pre 19.75 to post 8.24 for ARMS vs pre 21.02 to post 10.45 for Stretta, P = .70). DeMeester scores improved similarly after both procedures (pre 44.99 to post 15.02 for ARMS vs pre 52.29 to post 28.99 for Stretta, P = .48). ARMS was associated with higher overall morbidity (25% vs 17%, P = .001) and greater risks of stricture (odds ratio [OR], 13.03; 95% CI, 7.83-21.71), bleeding (OR, 13.16; 95% CI, 8.60-20.15), and perforation (OR, 13.03; 95% CI, 7.82-21.71) compared with Stretta.
Both Stretta and ARMS are effective endoscopic treatment modalities for GERD. Although their clinical efficacy appears to be similar, the increased risk of dysphagia, bleeding, and perforation after ARMS should not be underestimated.
胃食管反流病（GERD）影响10%至30%的人群。对于经过精心挑选的患者，已提出内镜抗反流治疗方法。在本研究中，我们比较了内镜抗反流黏膜切除术（ARMS）和内镜下食管下括约肌射频消融术（Stretta手术）治疗GERD的疗效。
利用MEDLINE数据库进行系统评价，以识别分析ARMS和Stretta手术后疗效的原始文章。主要结局指标为患者满意度、GERD健康相关生活质量（GERD-HRQL）评分、质子泵抑制剂（PPI）使用情况及DeMeester评分。次要结局指标为术后不良事件。采用比例的Meta分析和线性回归模型评估每种内镜手术对不同结局的影响。
纳入66项研究，共3767例患者，其中3074例（81.60%）接受Stretta手术，693例（18.40%）接受ARMS。ARMS的加权合并患者满意度为65%（95%置信区间[CI]，52-76），Stretta为77%（95%CI，64-87）。两种治疗均显著减少了PPI的使用（ARMS从100%降至40.18%，Stretta从99.42%降至48.51%，P = 0.20），并改善了GERD-HRQL评分（ARMS术前19.75分，术后8.24分；Stretta术前21.02分，术后10.45分，P = .70）。两种手术后DeMeester评分改善情况相似（ARMS术前44.99分，术后15.02分；Stretta术前52.29分，术后28.99分，P = 0.48）。与Stretta相比，ARMS的总体发病率更高（25%对17%，P = 0.001），发生狭窄（比值比[OR]，13.03；95%CI，7.83-21.71）、出血（OR，13.16；95%CI，8.60-20.15）和穿孔（OR，13.03；95%CI，7.82-21.71）的风险更大。
Stretta手术和ARMS都是治疗GERD有效的内镜治疗方式。尽管它们的临床疗效似乎相似，但ARMS术后吞咽困难、出血和穿孔风险增加不应被低估。
