| ObjectiveGastroesophageal reflux disease(GERD)is a common gastrointestinal disorder.PPI drugs are currently the main treatment modality.The drawbacks of this treatment are drug dependence and side effects.Medigus ultrasonic surgical endostapler(MUSE)is a new endoscopic surgical method to treat GERD.Recent studies have shown that MUSE is safe,effective and well tolerated.However,the experience of endoscopic fundoplication in Chinese is not known.Therefore,we conducted this prospective and self-controlled study to assess the safety and efficacy of endoscopic fundoplication treatment for Chinese patients with GERD.MethodFrom March 2017 to February 2019,eighteen GERD patients who underwent the endoscopic fundoplication in The First People’s Hospital were enrolled(14 males and4 females).The age was different from twenty-seven to sixty-two years old,mean age was 48.89±11.17 years.The patients were assessed through history data,pre-operative gastroscopy,esophageal manometry,24-hour esophageal p H and upper gastrointestinal radiography.Meanwhile,the operation process,postoperative quality of life score and postoperative complications were recorded.The primary endpoint was the improvement in GERD health-related quality of life(HRQL)score,reduction in dose of PPI medication,esophageal acid exposure,lower esophageal sphincter(LES)resting pressure,anatomical changes under gastroscopy,and complications to assess the efficacy and safety.Results18 patients were operated successfully.No perioperative death occurred.In terms of the primary outcome,(1)Postoperative GERD-HRQL scores were significantly lower than preoperative scores(28 points(range,14 to 36 points)at the baseline offmedication,and it reduced to 0 points(range,0 to 2points)at 3 months after procedure and 0 points(range,0 to 18 points)at 6 months P<0.01).(2)The mean percent of total time with esophageal p H<4.0 decreased from baseline 10.5%(range,5.2% to 74.5%)to6 months 3.3%(range,0.2% to 24.5%),P<0.01).De Meester also scored significantly reduced.(35.75 points(range,20.2-255.0)before surgery to 11.9 points(range,1.4-97.3),P<0.01).(3)LES resting pressure increased from 13.94 ± 7.68 mm Hg before procedure to 17.29 ± 7.00 mm Hg at 6 months,but there were not statistically significant(P=0.06).(4)Six months after the procedure,14/18(78%)patients reported a≥50 % reduction in daily PPI medication.In terms of complications,pneumothorax or mediastinal pneumothorax occurred in 2 patients,and minor subcutaneous emphysema occurred in 2 patients,only one of which required further surgical intervention.ConclusionsIn this prospective study,endoscopic anterior fundoplication was performed on the outpatient follow-up population.By comparing preoperative and postoperative GERD-HRQL score,gerd-q score,esophageal acid exposure test and other indicators,it was confirmed that endoscopic anterior fundoplication could significantly improve the clinical symptoms of patients,reduce acid reflux,and reduce the use rate of antiacid drugs.The operation is simple and has a short convalescence,easy to be accepted by patients,as well as a practical non-invasive treatment.Its long-term efficacy needs to be confirmed by further large sample,multi-center follow-up studies. |
PDF Full Text Request