AIM： To evaluate the efficacy, safety, and long-term outcomes of endoluminal gastroplication （ELGP） in pa- tients with proton pump inhibitor （PPI）-resistant, non- erosive reflux disease （NERD）. METHODS： The su...AIM： To evaluate the efficacy, safety, and long-term outcomes of endoluminal gastroplication （ELGP） in pa- tients with proton pump inhibitor （PPI）-resistant, non- erosive reflux disease （NERD）. METHODS： The subjects were NERD patients, diag- nosed by upper endoscopy before PPI use, who had symptoms such as heartburn or reflux sensations two or more times a week even after 8 wk of full-dose PPI treatment. Prior to ELGP, while continuing full-dose PPImedication, patients＇ symptoms and quality of life （QOL） were assessed using the questionnaire for the diagno- sis of reflux disease, the frequency scale for symptoms of gastro-esophageal reflux disease （FSSG）, gastroin- testinal symptoms rating scale, a 36-item short-form. In addition, 24-h esophageal pH monitoring or 24-h in- traesophageal pH/impedance （MII-pH） monitoring was performed. The Bard EndoCinchTM was used for ELGP, and 2 or 3 plications were made. After ELGP, all acid reducers were temporarily discontinued, and medica- tion was resumed depending on the development and severity of symptoms. Three mo after ELGP, symptoms, QOL, pH or MII-pH monitoring, number of plications, and PPI medication were evaluated. Further, symptoms, number of plications, and PPI medication were evalu- ated 12 mo after ELGP to investigate long-term effects. RESULTS： The mean FSSG score decreased signifi- cantly from before ELGP to 3 and 12 mo after ELGP （19.1 ：k 10.5 to 10.3 ＋ 7.4 and 9.3 ＋ 9.9, P 〈 0.05, respectively）. The total number of plications decreased gradually at 3 and 12 mo after ELGP （2.4 ＋ 0.8 to 1.2 ：l： 0.8 and 0.8 ：l： 1.0, P 〈 0.05, respectively）. The FSSG scores in cases with no remaining plications and in cases with one or more remaining plications were 4.4 and 2.7, respectively, after 3 too, and 2.0 and 2.8, respectively, after 12 mo, showing no correlation to plication loss. On pH monitoring, there was no differ- ence in the percent time pH 〈 4 from before ELGP to 3 mo after. Impedance monitoring revealed no changes in the number of reflux episodes or the symptom index for reflux events from before ELGP to 3 mo after, but the symptom sensitivity index decreased significantly 3 mo after ELGP （16.1：1：12.9 to 3.9 ~ 8.3, P 〈 0.01）. At 3 mo after ELGP, 6 patients （31.6%） had reduced their PPI medication by 50% or more, and 11 patients （57.9%） were able to discontinue PPI medication alto- gether. After 12 mo, 3 patients （16.7%） were able toreduce the amount of PPI medication by 50% or more, and 22 patients （66.7%） were able to discontinue PPI medication altogether. A high percentage of cases with remaining plications had discontinued PPIs medication after 3 mo, but there was no difference after 12 mo. No serious complications were observed in this study. CONCLUSION： ELGP was safe, resulted in significant improvement in subjective symptoms, and allowed less medication to be used over the long term in patients with PPI-refractory NERD.展开更多
基金Supported by In Part by a Grant for Medical Research from Aichi Medical University School of Medicine
文摘AIM： To evaluate the efficacy, safety, and long-term outcomes of endoluminal gastroplication （ELGP） in pa- tients with proton pump inhibitor （PPI）-resistant, non- erosive reflux disease （NERD）. METHODS： The subjects were NERD patients, diag- nosed by upper endoscopy before PPI use, who had symptoms such as heartburn or reflux sensations two or more times a week even after 8 wk of full-dose PPI treatment. Prior to ELGP, while continuing full-dose PPImedication, patients＇ symptoms and quality of life （QOL） were assessed using the questionnaire for the diagno- sis of reflux disease, the frequency scale for symptoms of gastro-esophageal reflux disease （FSSG）, gastroin- testinal symptoms rating scale, a 36-item short-form. In addition, 24-h esophageal pH monitoring or 24-h in- traesophageal pH/impedance （MII-pH） monitoring was performed. The Bard EndoCinchTM was used for ELGP, and 2 or 3 plications were made. After ELGP, all acid reducers were temporarily discontinued, and medica- tion was resumed depending on the development and severity of symptoms. Three mo after ELGP, symptoms, QOL, pH or MII-pH monitoring, number of plications, and PPI medication were evaluated. Further, symptoms, number of plications, and PPI medication were evalu- ated 12 mo after ELGP to investigate long-term effects. RESULTS： The mean FSSG score decreased signifi- cantly from before ELGP to 3 and 12 mo after ELGP （19.1 ：k 10.5 to 10.3 ＋ 7.4 and 9.3 ＋ 9.9, P 〈 0.05, respectively）. The total number of plications decreased gradually at 3 and 12 mo after ELGP （2.4 ＋ 0.8 to 1.2 ：l： 0.8 and 0.8 ：l： 1.0, P 〈 0.05, respectively）. The FSSG scores in cases with no remaining plications and in cases with one or more remaining plications were 4.4 and 2.7, respectively, after 3 too, and 2.0 and 2.8, respectively, after 12 mo, showing no correlation to plication loss. On pH monitoring, there was no differ- ence in the percent time pH 〈 4 from before ELGP to 3 mo after. Impedance monitoring revealed no changes in the number of reflux episodes or the symptom index for reflux events from before ELGP to 3 mo after, but the symptom sensitivity index decreased significantly 3 mo after ELGP （16.1：1：12.9 to 3.9 ~ 8.3, P 〈 0.01）. At 3 mo after ELGP, 6 patients （31.6%） had reduced their PPI medication by 50% or more, and 11 patients （57.9%） were able to discontinue PPI medication alto- gether. After 12 mo, 3 patients （16.7%） were able toreduce the amount of PPI medication by 50% or more, and 22 patients （66.7%） were able to discontinue PPI medication altogether. A high percentage of cases with remaining plications had discontinued PPIs medication after 3 mo, but there was no difference after 12 mo. No serious complications were observed in this study. CONCLUSION： ELGP was safe, resulted in significant improvement in subjective symptoms, and allowed less medication to be used over the long term in patients with PPI-refractory NERD.
