未经批准:内镜治疗越来越多地用于难治性胃食管反流病(GERD)。三个程序具有相似的概念和技术:抗反流粘膜切除术(ARMS),抗反流粘膜消融(ARMA),和抗反流带结扎(ARBL);我们统称为抗反流粘膜干预(ARMI)。这里,我们系统回顾了临床结局和技术方面.
未经授权:PubMed,Embase,从开始到2021年10月,搜索了Cochrane图书馆数据库。主要结果是临床成功率。次要结果是酸暴露时间,DeMeester得分,需要质子泵抑制剂(PPI),内镜检查结果,和不良事件。
未经评估:共纳入15项研究。总体临床成功率为73.8%(95%置信区间(CI)=69%-78%),使用ARMS的68.6%(95%CI=62.2%-74.4%),ARMA患者占86.7%(95%CI=78.7%-91.9%),ARBL患者为76.5%(95%CI=65%-85.1%)。ARMI显著改善了酸暴露时间,DeMeester得分,和食管裂孔疝的程度。此外,10%的患者有吞咽困难,需要在ARMS或ARMA后进行内镜扩张,ARMS与2.2%的穿孔率相关。相比之下,没有出血,穿孔,或ARBL出现严重吞咽困难。严重的食管裂孔疝(HillIII级)可以预测ARMA的治疗失败。
未经证实:三种ARMI程序对PPI难治性GERD有效且安全。ARMA和ARBL可能优于ARMS,因为它们具有较少的不良事件和相似的疗效。需要进一步的研究来确定最佳技术和患者选择。
UNASSIGNED: Endoscopic treatments are increasingly being offered for refractory gastroesophageal reflux disease (GERD). Three procedures have similar concepts and techniques: antireflux mucosectomy (ARMS), antireflux mucosal ablation (ARMA), and antireflux band ligation (ARBL); we have collectively termed them antireflux mucosal intervention (ARMI). Here, we systematically reviewed the clinical outcomes and technical aspects.
UNASSIGNED: The PubMed, Embase, and Cochrane Library databases were searched from inception to October 2021. The primary outcome was the clinical success rate. The secondary outcomes were acid exposure time, DeMeester score, need for proton pump inhibitors (PPIs), endoscopic findings, and adverse events.
UNASSIGNED: Fifteen studies were included. The pooled clinical success rate was 73.8% (95% confidence interval (CI) = 69%-78%) overall, 68.6% (95% CI = 62.2%-74.4%) with ARMS, 86.7% (95% CI = 78.7%-91.9%) with ARMA, and 76.5% (95% CI = 65%-85.1%) with ARBL. ARMI resulted in significantly improved acid exposure time, DeMeester score, and degree of hiatal hernia. Furthermore, 10% of patients had dysphagia requiring endoscopic dilatation after ARMS or ARMA, and ARMS was associated with a 2.2% perforation rate. By contrast, no bleeding, perforation, or severe dysphagia was noted with ARBL. Severe hiatal hernia (Hill grade III) may predict treatment failure with ARMA.
UNASSIGNED: The three ARMI procedures were efficacious and safe for PPI-refractory GERD. ARMA and ARBL may be preferred over ARMS because of fewer adverse events and similar efficacy. Further studies are necessary to determine the optimal technique and patient selection.