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Is patient satisfaction sufficient to validate endoscopic anti-reflux treatments?

World Journal of Gastroenterology 2022年第28期28卷 3743-3746页

作者： Mauro Bortolotti Department of Internal Medicine and Gastroenterology S.Orsola-Malpighi PolyclinicUniversity of BolognaBologna 40138Italy

Endoscopic anti-reflux treatment is emerging as a new option for gastroesophageal reflux disease(GERD)treatment in patients with the same indications as for laparoscopic fundoplication.There are many techniques,the first of which are transoral incisionless fundoplication(TIF)and nonablative radio-frequency(STRETTA)that have been tested with comparative studies and randomized controlled trials,whereas the other more recent ones still require a deeper evaluation.The purpose of the latter is to verify whether reflux is abolished or significantly reduced after intervention,whether there is a valid high pressure zone at the gastroesophageal junction,and whether esophagitis,when present,has disappeared.Unfortunately in a certain number of cases,and especially in the more recently introduced ones,the evaluation has been based almost exclusively on subjective criteria,such as improvement in the quality of life,remission of heartburn and regurgitation,and reduction or suspension of antacid and antisecretory drug consumption.However,with the most studied techniques such as TIF and STRETTA,an improvement in symptoms better than that of laparoscopic fundoplication can often be observed,whereas the number of acid episodes and acid exposure time are similar or higher,as if the acid refluxes are better tolerated by these patients.The suspicion of a local hyposensitivity taking place after antireflux endoscopic intervention seems confirmed by a Bernstein test at least for STRETTA.This examination should be done for all the other techniques,both old and new,to identify the ones that reassure rather than cure.In conclusion,the evaluation of the effectiveness of the endoscopic anti-reflux techniques should not be based exclusively on subjective criteria,but should also be confirmed by objective examinations,because there might be a gap between the improvement in symptoms declared by the patient and the underlying pathophysiologic alterations of GERD.

关键词： Endoscopic anti-reflux treatment Transoral incisionless fundoplication Nonablative radio-frequency anti-reflux mucosectomy Gastro-esophageal reflux disease Laparoscopic Nissen fundoplication

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Endoscopic anti-reflux therapy for gastroesophageal reflux disease

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World Journal of Gastroenterology 2021年第39期27卷 6601-6614页

作者： Enrique Rodríguez de Santiago Eduardo Albéniz Fermin Estremera-Arevalo Carlos Teruel Sanchez-Vegazo Vicente Lorenzo-Zúñiga Department of Gastroenterology and Hepatology Hospital Universitario Ramón y CajalInstituto Ramón y Cajal de Investigación Sanitaria(IRYCIS)Madrid 28034Spain Endoscopy Unit Gastroenterology DepartmentHospital Universitario de Navarra.Gastrointestinal Endoscopy Research UnitNavarrabiomed Biomedical Research Center.PamplonaSpain Endoscopy Unit Gastroenterology DepartmentHospital Universitari i Politècnic La FeInstituto de Investigación Sanitaria La Fe(IIS La Fe)Valencia 46026Spain

Gastroesophageal reflux disease has an increasing incidence and prevalence worldwide.A significant proportion of patients have a suboptimal response to proton pump inhibitors or are unwilling to take lifelong medication due to concerns about long-term adverse effects.Endoscopic anti-reflux therapies offer a minimally invasive option for patients unwilling to undergo surgical treatment or take lifelong medication.The best candidates are those with a good response to proton pump inhibitors and without a significant sliding hiatal hernia.Transoral incisionless fundoplication and nonablative radiofrequency are the techniques with the largest body of evidence and that have been tested in several randomized clinical trials.Band-assisted ligation techniques,anti-reflux mucosectomy,antireflux mucosal ablation,and new plication devices have yielded promising results in recent noncontrolled studies.Nonetheless,the role of endoscopic procedures remains controversial due to limited long-term and comparative data,and no consensus exists in current clinical guidelines.This review provides an updated summary focused on the patient selection,technical details,clinical success,and safety of current and future endoscopic anti-reflux techniques.

关键词： Treatment Gastroesophageal reflux Transoral incisionless fundoplication anti-reflux mucosectomy anti-reflux mucosal ablation Stretta

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