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LINX^(■) reflux management system to bridge the “treatment gap” in gastroesophageal reflux disease: A systematic review of 35 studies

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World Journal of Clinical Cases 2020年第2期8卷 294-305页

作者： Dimitrios Schizas Aikaterini Mastoraki Eleni Papoutsi Vassilis G Giannakoulis Prodromos Kanavidis Diamantis Tsilimigras Dimitrios Ntourakis orestis lyros Theodore Liakakos Dimitrios Moris 1^(st) Department of Surgery National and Kapodistrian University of AthensLaikon HospitalAthens 11527Greece 4^(th） Department of Surgery National and Kapodistrian University of AthensAttikon University HospitalChaidariAthens 11527Greece Department of Surgery Division of Surgical OncologyThe Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research InstituteColumbusOH 45830United States Department of Surgery School of MedicineEuropean University CyprusNicosia 2404Cyprus Department of Visceral TransplantThoracic and Vascular SurgeryUniversity Hospital LeipzigLeipzig 04103Germany Department of Surgery Duke University Medical CenterDuke UniversityDurhamNC 27705United States

BACKGROUND Gastroesophageal reflux disease(GERD) occurs when the reflux of stomach contents causes troublesome symptoms and/or complications. When medical therapy is insufficient, surgical therapy is indicated and, until now, Laparoscopic fundoplication(LF) constitutes the gold-standard method. However, magnetic sphincter augmentation(MSA) using the LINX^® Reflux Management System has recently emerged and disputes the standard therapeutic *** To investigate the device’s safety and efficacy in resolving GERD *** This is a systematic review conducted in accordance to the PRISMA *** searched MEDLINE, ***, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL databases from inception until September *** Overall, 35 studies with a total number of 2511 MSA patients were included and analyzed. Post-operative proton-pump inhibitor(PPI) cessation rates reached 100%, with less bloating symptoms and a better ability to belch or vomit in comparison to LF. Special patient groups(e.g., bariatric or large hiatal-hernias)had promising results too. The most common postoperative complication was dysphagia ranging between 6% and 83%. Dilation due to dysphagia occurred in 8% of patients with typical inclusion criteria. Esophageal erosion may occur in up to 0.03% of patients. Furthermore, a recent trial indicated MSA as an efficient alternative to double-dose PPIs in moderate-to-severe *** The findings of our review suggest that MSA has the potential to bridge the treatment gap between maxed-out medical treatment and LF. However, further studies with longer follow-up are needed for a better elucidation of these results.

关键词： LINX^(■) reflux management system Magnetic sphincter augmentation Gastroesophageal reflux disease Gastroesophageal reflux disease-health-related quality of life

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Multidisciplinary management of gastric and gastroesophageal cancers

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World Journal of Gastroenterology 2008年第24期14卷 3773-3780页

作者： Markus Moehler orestis lyros Ines Gockel Peter R Galle Hauke Lang First Department of Internal Medicine of Johannes Gutenberg University of Mainz Institute of Surgery of Johannes Gutenberg University of Mainz

Carcinomas of the stomach and gastroesophageal junction are among the five top leading cancer types worldwide. In spite of radical surgical R0 resections being the basis of cure of gastric cancer, surgery alone provides long-term survival in only 30% of patients with advanced International Union Against Cancer （UICC） stages in Western countries because of the high risk of recurrence and metachronous metastases. However, recent large phase-Ⅲ studies improved the diagnostic and therapeutic options in gastric cancers, indicating a more multidisciplinary management of the disease. Multimodal strategies combining different neoadjuvant and/or adjuvant protocols have clearly improved the gastric cancer prognosis when combined with surgery with curative intention. In particular, the perioperative （neoadjuvant, adjuvant） chemotherapy is now a well-established new standard of care for advanced tumors. Adjuvant therapy alone should be carefully discussed after surgical resection, mainly in individual patients with large lymph node positive tumors when neoadjuvant therapy could not be done. The palliative treatment options have also been remarkably improved with new chemotherapeutic agents and will further be enhanced with targeted therapies such as different monoclonal antibodies. This article reviews the most relevant literature on the multidisciplinary management of gastric and gastroesophageal cancer, and discusses future strategies toimprove Iocoregional failures.

关键词： Gastric cancer Chemotherapy Chemoradiation Adjuvant Neoadjuvant

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