Efficacy Of A Domestic Endoscopic Radiofrequency Ablation Instrument For Gastroesophageal Reflux Disease

Objective:To investigate the efficacy of a domestic endoscopic radiofrequency ablation instrument for gastroesophageal reflux disease(GERD).Methods:Fifty patients with refractory GERD admitted to our hospital from June 2016 to June 2017 were enrolled for the study,including 36 males and 14 females,aged 20-75 years old(average: 52.1 + 6.6),9 cases with hiatal hernia.Their disease types were non-erosive reflux disease(25 cases),reflux esophagitis(22 cases),Barrett esophagus(3 cases).They were divided into endoscopic radiofrequency treatment group and drug treatment group by random number table,25 cases in each group.On this basis of lifestyle changes,patients in the drug treatment group were given Esmoloprazole(40 mg/time,twice a day for 8 weeks),then adjusting the drug according to the severity of the symptoms,whose specific scheme was that if the symptoms such as acid regurgitation and heartburn are not relieved after 8 weeks of continuous treatment with double PPIs dose,the dosage can be maintained and the medication cycle can be prolonged;if the clinical symptoms are relieved after 8 weeks of continuous treatment with double PPIs dose,the medication can be stopped for observation and carried out at random.Once the phenomenon including heartburn and acid regurgitation occurred,patients took the drugas as needed.Endoscopic radiofrequency ablation was performed in the endoscopic radiofrequency therapy group on the basis of lifestyle changes through Medi? radiofrequency instrument.The MER-200 G radiofrequency catheter was introduced into the esophagus along the guide wire.After the catheter balloon was placed at the treatment level,the balloon was properly inflated and dilated,and then the electrode needle was inserted into the esophageal wall to activate the Medi? radiofrequency instrument,whose energy temperature of radio frequency was 85 C and the surface temperature of mucosa was less than 50 C.We carried out 20 treatment planes of esophagus and cardia for 80 treatment points,each group lasted for 1 minute.Fluid was eaten 2 hours after operation,and patients could get out of bed.They could be discharged after 2 to 4 hours of observation.Esomeprazole Magnesium Enteric-coated Tablets were orally administered 20 mg/time,twice a day for 4 weeks,and then taken according to the symptoms.The esophageal and gastric fundus mucosa was observed immediately after the operation in endoscopic radiofrequency treatment group,and gastroscopy was reexamined 6 and 12 months after the intervention.GerdQ was performed to assess the severity of clinical symptoms before and 3,12 months after intervention,and PPI drug use was recorded at the same time.SF-36 questionnaire was performed to evaluate the quality of life of patients before and 12 months after intervention.The complications such as fever,mucosal hemorrhage,laceration,perforation,abnormal chest pain,abdominal distension and dysphagia were recorded during and after endoscopic radiofrequency ablation.Results:1.Gastroscopy immediately after intervention in endoscopic radiofrequency ablation group indicated that the gastrointestinal mucosa in treatment area contracted and thickened.2.There were no significant differences in the 24-hour dynamic gastroesophageal pH monitoring indexes including long reflux frequency,long reflux duration,total reflux frequency and DeMeester score between endoscopic radiofrequency treatment group and drug treatment group(P > 0.05).The indexes including long reflux frequency,long reflux duration,total reflux frequency and DeMeester score at 3 months after intervention in endoscopic radiofrequency treatment group and drug treatment group were significantly lower than those before intervention(P<0.05).The indexes including long reflux frequency,long reflux duration,total reflux frequency and DeMeester score in endoscopic radiofrequency treatment group were significantly lower than those in drug treatment group(P < 0.05).3.The total GerdQ scores before intervention in endoscopic radiofrequency treatment group and drug treatment group were(14.3±1.9)points and(13.9±2.2)points respectively,and there was no significant difference between two groups(t=0.688,P>0.05).The total score of GerdQ at 3 and 12 months after intervention in endoscopic radiofrequency group were(8.9±4.1)points and(6.6±3.5)points respectively,while those of drug treatment group were(11.5±3.9)points and(9.6±4.3)points respectively,and they were significantly lower than those before intervention(P<0.05).The total score of GerdQ at 3 and 12 months after intervention in endoscopic radiofrequency treatment group was significantly lower than that in drug treatment group(t = 2.297,2.705,P < 0.05).4.All patients need drugs to alleviate symptoms before intervention.The PPIs drug use rate at 3 and 12 months after intervention in endoscopic radiofrequency treatment group was 48.0%(12/25)and 20.0%(5/25)respectively,which were significantly lower t han 80.0%(20/25)and 48.0%(12/25)in drug treatment group(c2 = 5.556,4.367,P < 0.05).)5.There were no significant differences in the scores of physiological activity,physiological function,physical pain,vitality,emotional function,mental state,social function and general health of SF-36 scale before intervention between two groups(P > 0.05).The scores of physiological function,physical pain,vitality,mental state and general health of SF-36 scale in endoscopic radiofrequency treatment group were significantly higher than those before intervention,while vitality and general health of SF-36 scale in drug treatment group were significantly higher than those before intervention(P < 0.05).The scores of physiological function,vitality,mental state and general health of SF-36 scale in endoscopic radiofrequency treatment group were significantly higher than those in drug treatment group at the same time(P < 0.05).6.Postoperative complications of endoscopic radiofrequency therapy included two cases with abdominal distension and one case with a small amount of bleeding in cardiac mucosa,all of which were self-limited and not need intervention.There were no serious adverse reactions and long-term complications such as mucosal tear,perforation,dysphagia and high fever.Conclusion:Medi? radiofrequency instrument is a safe and effective treatment option for patients with GERD.It could significantly improve esophageal acid exposure,alleviate reflux symptoms,reduce the use of PPIs drugs,improve the quality of life,and achieve satisfactory short-term results.