Year 2023 / Volume 115 / Number 9
Original
A novel modified endoscopic method for treating patients with refractory gastro-esophageal disease and moderate hiatus hernia

496-503

DOI: 10.17235/reed.2023.9422/2022

Sun-Jun Gao, Zhen Zhu, Li Zhang, Jian Yin, Xiu-Fan Ni, Lei Chen,

Abstract
Background and aim: endoscopic anti-reflux mucosectomy (ARMS) is effective for patients with refractory gastroesophageal reflux disease (rGERD) with small hiatus hernia. However, evidence of its applicability in patients with larger hernia sac is lacking. This study aimed to evaluate the efficiency and safety of ARMS for patients with rGERD with moderate hiatus hernia (3-5 cm) and determine the appropriate resection range. Methods: thirty-six patients with rGERD with moderate hiatus hernia were enrolled. They were divided into 2/3 and 3/4 circumferential mucosal resection groups. The patients received modified ARMS. The gastroesophageal reflux disease questionnaire (GERD-Q) and DeMeester scores, endoscopy, 24-h pH monitoring results and lower esophageal sphincter (LES) resting pressure were compared pre- and post-procedure. Therapeutic effects and complications of the two mucosal resection ranges were analyzed. Results: thirty-six patients were enrolled in this study, all of whom had undergone ARMS surgery with at least six-month follow-up. In the 2/3 circumferential mucosal resection group, the GERD-Q score, acid exposure time (AET) and DeMeester score improved significantly compared with those before surgery (p < 0.001). In the 3/4 circumferential mucosal resection group, the GERD-Q score, AET and DeMeeter score worsened after six months (p < 0.001), but there was no difference between the two groups (p > 0.05). In both groups, there was no significant improvement in the ratio of esophagitis grade C/D and LES resting pressure after treatment compared with the baseline values (p > 0.05), and no postoperative bleeding or perforation was observed. The incidence of postoperative esophageal stenosis in the 2/3 circumferential mucosal resection group was lower than that in the 3/4 circumferential mucosal resection group (p = 0.041). Conclusion: modified ARMS is effective for patients with rGERD with moderate hiatus hernia, but it cannot significantly increase the postoperative resting pressure of the LES. The 2/3 circumferential mucosal resection can reduce the incidence of postoperative esophageal stenosis.
Lay Summary
Gastroesophageal reflux disease (GERD) is a common digestive system disorder with a worldwide prevalence of 8%–33%. These patients usually suffer from troublesome symptoms, including heartburn, nausea, and foreign body sensation. These symptoms significantly affect patient quality of life, mental health, sleep quality, and work productivity. However, only 40% of patients with GERD are amenable to proton pump inhibitor (PPI) and lifestyle modification therapy. Tipical endoscopic operations for rGERD patients, such as radiofrequency ablation (RFA), transoral incisionless fundoplication (TIF), and gastroesophageal junction plication were proved to be efficient and less invasive, but the expensive equipment required still hinders their wide use. Recently, the anti-reflux mucosectomy (ARMS) become an alterative method for these patients, which can remodel the anti-reflux barrier by excising a 3 cm crescent-shaped mucosa up and down the dentate line of the esophagus, however, evidence is lacking on the efficacy of ARMS for patients with larger hiatus hernia. Thus, we designed this prospective-controlled approach to investigate the suitability of ARMS in patients with rGERD with a 3–5 cm hernia sac. We also investigated the appropriate resection ranges for patients with rGERD considering both efficacy and safety.
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Gao S, Zhu Z, Zhang L, Yin J, Ni X, Chen L, et all. A novel modified endoscopic method for treating patients with refractory gastro-esophageal disease and moderate hiatus hernia. 9422/2022


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Publication history

Received: 13/12/2022

Accepted: 04/04/2023

Online First: 19/04/2023

Published: 06/09/2023

Article revision time: 83 days

Article Online First time: 127 days

Article editing time: 267 days


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