目的:目前尚无难治性胃食管反流病(GERD)的明确治疗方法。使用氩等离子体凝固的抗反流粘膜切除术(ARMS)和抗反流粘膜消融(ARMA)是有前途的方法。然而,没有研究比较这两者。本研究比较了两种方法的疗效和安全性。
方法:这个多中心,回顾性,观察性研究包括274例患者;96例和178例患者接受了ARMA和ARMS,分别。主要结果是基于GERD问卷(GERDQ)评分的主观症状改善。次要结果包括Barrett食管的改变,洛杉矶级反流性食管炎,瓣阀等级,和质子泵抑制剂戒断率。
结果:ARMS组基线GERDQ评分较高(10.0vs.8.0,P<0.001),术后中位改善高于ARMA组(4.0vs.2.0,P=0.002),即使在倾向得分匹配调整后,这些发现仍然存在。与ARMA相比,ARMS明显改善反流性食管炎,洛杉矶等级(P<0.001)和瓣阀等级评分(P<0.001)发生显着变化。Barrett食管的改善在两组之间具有可比性(P=0.337),ARMS和ARMA组的分辨率分别为94.7%和77.8%,分别。与ARMA组相比,ARMS组出血率较高(P=0.034),相当的狭窄率(P=0.957),和更多的质子泵抑制剂退出(P=0.008)。
结论:ARMS和ARMA均显示GERDQ评分有所改善,内镜下食管炎,瓣阀等级,手术后出现了Barrett的食道.然而,在主观和客观指标方面,ARMS表现出比ARMA更好的结果。
OBJECTIVE: No definitive treatment has been established for refractory gastroesophageal reflux disease (GERD). Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) using argon plasma coagulation are promising methods. However, no study has compared these two. This study compared the efficacy and safety of the two procedures.
METHODS: This multicenter, retrospective, observational study included 274 patients; 96 and 178 patients underwent ARMA and ARMS, respectively. The primary outcome was subjective symptom improvement based on GERD questionnaire (GERDQ) scores. The secondary outcomes included changes in the presence of Barrett\'s esophagus, Los Angeles grade for reflux esophagitis, flap valve grade, and proton pump inhibitor withdrawal rates.
RESULTS: The ARMS group had higher baseline GERDQ scores (10.0 vs. 8.0, P < 0.001) and a greater median postprocedure improvement than the ARMA group (4.0 vs. 2.0, P = 0.002), and even after propensity score matching adjustment, these findings remained. ARMS significantly improved reflux esophagitis compared with ARMA, with notable changes in Los Angeles grade (P < 0.001) and flap valve grade scores (P < 0.001). Improvement in Barrett\'s esophagus was comparable between the groups (P = 0.337), with resolution rates of 94.7% and 77.8% in the ARMS and ARMA groups, respectively. Compared with the ARMA group, the ARMS group experienced higher bleeding rates (P = 0.034), comparable stricture rates (P = 0.957), and more proton pump inhibitor withdrawals (P = 0.008).
CONCLUSIONS: Both ARMS and ARMA showed improvements in GERDQ scores, endoscopic esophagitis, flap valve grade, and the presence of Barrett\'s esophagus after the procedures. However, ARMS demonstrated better outcomes than ARMA in terms of both subjective and objective indicators.