胃食管反流病的内镜治疗进展

胃食管反流病(GERD)是指过多的胃、十二指肠内容物反流入食管引起烧心等症状,伴食管pH的改变,内镜检查可见食管黏膜糜烂等的一种表现。若仅有症状或食管pH改变,内镜检查阴性,则称为内镜阴性GERD或非糜烂性胃食管反流病(NERD)。目前认为短暂性食管下端括约肌(LES)松弛是GERD的最主要原因。     

胃食管反流病的外科及内镜治疗现状

胃食管反流病(GERD)的治疗包括多方面或综合性的治疗,消化内科医生也应该了解外科和内镜治疗.     

胃食管反流病的内镜治疗

胃食管反流病（Gastro-esophageal reflux disease ,GERD）的发病北有增高趋势，其治疗包括生活方式的改变和长期的制酸药物维持。近年来，多种内镜介入治疗方法被应用于CERD的治疗，现综述如下。     

胃食管反流病的内镜治疗进展

胃食管反流病(gastroesophageal reflux disease，GERD)是指胃或十二指肠内容物反流入食管，引起症状或并发症。主要表现为胸骨后痛、烧心、反酸或食物反流；可引起食管糜烂、溃疡、出血、狭窄等，称反流性食管炎。GERD非常常见，西方国家约10％的人患有此病，老年人约1／4患有GERD。我国该病的发病率具体不详，京沪二地调查约6％的人患有GERD。GERD的发病机制尚不完全清楚，一般认为食管下括约肌功能障碍或食管运动减弱，胃肠内容物的化学损伤及食管黏膜防御功能减弱等与其有关。其治疗主要有药物治疗、外科治疗、腹腔镜下治疗及近年开展的胃镜下治疗等。     

胃食管反流病的外科治疗

GERD的治疗原则是缓解症状 ,预防和治疗重要并发症 ,预防 GERD复发。多数患者应用胃肠动力药物、抑酸剂和粘膜保护剂后症状缓解 ,尤其是质子泵抑制剂对酸的抑制最强 ,治疗效果满意 ,但也有相当一部分病例需要外科治疗。现简述GERD的外科治疗。1　手术适应症1需长期用药维持 ,且用药后症状仍然严重者 ;2内科治疗停药后很快出现症状且反复发作者 ;3出现严重并发症 ,如出血、穿孔、狭窄等 ,经药物或内镜治疗无效者 ;4Barrett食管可疑癌变者 ;5严重的胃食管反流而不愿终生服药者 ;6仅对大剂量质子泵抑制剂起效的年轻患者。2　术式抗反流手…     

胃食管反流病的内镜治疗进展

胃食管反流病是一种常见的上消化道动力障碍疾病 ,目前的治疗主要是抑制胃酸分泌药物和腹腔镜Nissen胃底折叠术。内镜抗反流治疗技术是近几年出现的很有前景的新方法 ,包括内镜下缝合术、射频治疗技术和内镜下植入治疗等 ,这些方法都取得较好的效果。此文就胃食管反流病的内镜治疗方面的进展作一综述     

胃食管反流病的内镜治疗进展

胃食管反流病是一种常见的上消化道动力障碍疾病，目前的治疗主要是抑制胃酸分泌药物和腹腔镜Nissen胃底折叠术。内镜抗反流治疗技术是近几年出现的很有前景的新方法，包括内镜下缝合术、射频治疗技术和内镜下植入治疗等，这些方法都取得较好的效果。此文就胃食管反流病的内镜治疗方面的进展作一综述。     

胃食管反流病内镜治疗的评价

胃食管反流病(gastro-esophageal reflux disease，GERD)是临床常见病，严重影响广大病人的生活质量。目前治疗的主要药物为质子泵抑制剂(proton pump inhibitor，PPI)，但仍有20％患者药物治疗无效，约20％患者因停药后复发而需要长期大剂量PPI维持，给患者带来巨大经济负担，近年来，随着内镜技术的不断发展与完善，国外学者对内镜治疗GERD进行了一些探索和研究，获得令人鼓舞的效果。     

Endoscopic therapy for gastroesophageal reflux disease

Many new and developing endoscopic techniques for treatment of gastroesophageal reflux disease (GERD) are now or will soon be available for clinical use. These new therapies are directed to the gastroesophageal junction and include three basic techniques, which are outlined in this review: thermal remodeling and neurolysis of the lower esophageal sphincter (LES) zone; bulking or reinforcing of the LES; and plicating gastric folds at the gastric cardia. Only two of these treatments, radiofrequency ablation and fundic fold plication, have been approved by the US Food and Drug Administration (FDA). Published clinical research on endoscopic treatment is reviewed, although it is mostly comprised of open-label trials and anecdotal clinical reports. Complications of endoscopic GERD treatments are described as well as real and potential pitfalls of these techniques. Problems caused by premature introduction of endoscopic GERD treatments into the marketplace are also discussed, along with the rationale for FDA approval of similar devices.     

Endoscopic therapy for gastroesophageal reflux disease

Endoscopic therapies aimed to reduce gastroesophageal reflux have gained an enormous enthusiasm during the last 5 years when several of them were approved by the regulatory agencies and released on the market. These novel therapies comprise 3 types of techniques: injection/bulking, plicating/suturing and radiofrequency thermal injury. Open-labelled trials performed on proton pump inhibitors-responding patients with typical gastroesophageal reflux disease (GERD) symptoms have shown an improvement in reflux symptoms during short term follow-up. Longer-term data are now available and show disappointing results with partial-thickness plications of the cardia. Randomized sham-controlled trials, which are essential to proof the efficacy of GERD endotherapy because of a known high placebo effect in the management of GERD patients, have been conducted, one with radiofrequency and one with polymer injection, and have confirmed the clinical efficacy of both techniques, although the clinical benefit was less impressive than suggested in open-labelled trials. While mechanistic studies have suggested that the compliance of the gastroesophageal junction might be altered by GERD endotherapy, objective assessment of acid reflux with ambulatory pH-metry has shown, however, minimal or no modification by the treatment. Concerns about the safety of these new techniques have raised when complications were reported as the number of treated cases increased. Currently, no definite indication is established for each technique, but numerous potential indications exist and should be addressed in the setting of carefully designed clinical trials. Physicians should be patient and wait for proof of efficacy and safety of these techniques before using them in their clinical practice. Specific and extensive warning should be obtained before starting clinical application. The present review aims to provide a comprehensive and critical view of endoscopic therapy in GERD management.     

Endoscopic anti-reflux therapy for gastroesophageal reflux disease

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, anti-reflux 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.     

Endoscopic therapies of gastroesophageal reflux disease

The high prevalence of gastroesophageal reflux disease (GERD) in Western societies has accelerated the need for new modalities of treatment. Currently, medical and surgical therapies are widely accepted among patients and physicians. New potent antisecretory drugs and the development of minimally invasive surgery for the management of GERD are at present the pivotal and largely accepted approaches to treatment. The minimally invasive treatment revolution, however, has stimulated several new endoscopic techniques for GERD. Up to now, the data is limited and further studies are necessary to compare the advantages and disadvantages of the various endoscopic techniques to medical and laparoscopic management of GERD. New journal articles and abstracts are continuously being published. The Food and Drug Administration has approved 3 modalities, thus gastroenterologists and surgeons are beginning to apply these techniques. Further trials and device refinements will assist clinicians. This article will present an overview of the various techniques that are currently on study. This review will report the efficacy and durability of various endoscopic therapies for gastroesophageal reflux disease (GERD). The potential for widespread use of these techniques will also be discussed. Articles and abstracts published in English on this topic were retrieved from Pubmed. Due to limited number of studies and remarkable differences between various trials, strict criteria were not used for the pooled data presented, however, an effort was made to avoid bias by including only studies that used off-PPI scoring as baseline and intent to treat.     

Endoscopic treatment of gastroesophageal reflux disease

"Gastroesophageal reflux disease is a chronic illness with a wide spectrum of symptoms that can significantly affect people's quality of life and increase the risk of complications, including cancer. Gastroesophageal reflux disease has been primarily treated with anti-secretory medications and, when needed, surgery. However, caveats to this approach include long-term medications, side effects, drug-interaction, cost, and the morbidity and mortality associated with surgery. Endoscopic management of gastroesophageal reflux disease offers a safe, effective and less invasive alternative to medications and surgery. There are different endoscopic therapies that include suturing, application of radiofrequency, injection of polymer, and placement of prostheses. The available data on these therapies is here discussed".     

Endoscopic therapy for gastroesophageal reflux disease: a systematic review

Endoscopic therapy has emerged as an alternative for patients with symptomatic gastroesophageal reflux disease (GERD) who are seeking a non-pharmacologic, non-surgical intervention. To date, there are 3 basic categories of these endoscopic options: radiofrequency ablation, endoscopic suturing and endoscopic injection. Although the pivotal clinical studies to date have consistently demonstrated efficacy for defined endpoints of symptom control, GERD health related quality of life and discontinuance of acid secretory medications, depending on the therapy, there has been less consistent improvement in objective parameters of pH control and lower esophageal sphincter pressure. Although the data for these procedures has been favorable, extrapolation to justify a more widespread clinical use has been limited by the relative lack of controlled sham studies-although these are currently underway for all of the available therapies. Appropriate patient selection for endoscopic GERD therapy is critical and at present these therapies have the best clinical outcome data in patients who are responsive to therapy with a proton pump inhibitor. The risk/benefit profile, long term durability and cost effectiveness should be considered in all patients being considered when evaluating each of the endoscopic therapies for GERD.     

Endoscopic therapy for gastroesophageal reflux disease: a systematic review

The high prevalence of gastroesophageal reflux disease (GERD) in Western societies has accelerated the need for new modalities of treatment. Currently, medical and surgical therapies are widely accepted among patients and physicians. The minimally invasive treatment revolution, however, has stimulated several new endoscopic techniques for GERD. Up to now, the data is limited and further studies are necessary to compare the advantages and disadvantages of the various endoscopic techniques to medical and laparoscopic management of GERD. This systematic review reports the efficacy and durability of various endoscopic therapies for GERD whilst the potential for widespread use of these techniques is also discussed. Despite the limited number of studies and remarkable differences between various trials, strict criteria were used for the pooled data presented and an effort was made to avoid bias by including only studies that used off-antisecretory medication scoring as baseline and intent to treat.     

Endoscopic therapies for gastroesophageal reflux disease

Although medical and surgical treatments are available for gastroesophageal reflux disease, endoscopic therapies for this condition are relatively new. This review describes the principles behind such treatments as well as the individual procedures themselves, focusing on mechanisms of action, safety and tolerability, and efficacy in animal and human clinical trials. Future trends in endoscopic therapy are discussed.