Comparison Of Peroral Endoscopic Cardial Constriction And Laparoscopic Nissen Fundoplication For Gastroesophageal Reflux Disease

BackgroundGastroesophageal reflux disease(GERD)is a common digestive tract disease in the world,and its incidence rate in China is about 5.77%.In recent years,the prevalence of GERD has been on the rise year by year with the change of people's living habits,dietary structure,and increasing work and mental stress.Most patients with GERD can effectively control their reflux symptoms only through improved lifestyle and medication,but up to 40% of patients still present with refractory gastroesophageal reflux disease(RGERD),which means that after 8 weeks of treatment with standard dose proton pump inhibitor(PPI),the symptoms of GERD have no relief or poor efficacy.GERD is a potential risk factor for the development of Barrett's esophagus and esophageal adenocarcinoma,and long-term history of GERD may lead to different types of respiratory diseases,and repeated symptoms of GERD seriously affect the physical and mental health of patients.In recent years,with the development of medical technology,endoscopic treatment and surgical treatment of GERD have gradually come into people's sight.For GERD patients with poor long-term drug treatment and extra-esophageal symptoms,endoscopic treatment or surgical treatment may be considered after confirmation of various examinations in combination with the type of reflux symptoms,the duration of symptoms and the relationship between etiology and time.The commonly used surgical methods include Nissen,Toupet and Dor,while Stretta radiofrequency therapy and TIF are more mature in the development of endoscopic therapy.Different treatment methods have their own advantages and disadvantages.Peroral Endoscopic Cardial Constriction(PECC)is a new method for the treatment of GERD pioneered by professor linghu enqiang in 2013.It is simple to operate,has fewer complications and faster postoperative recovery,which has gradually been favored and valued by clinicians and patients.However,there are few relevant studies,and more long-term follow-up and randomized trials are needed to evaluate the effectiveness and sustainability of this approach compared with traditional treatment methods.ObjectiveThe purpose of this study was to compare and analyze the therapeutic effect of PECC and laparoscopic Nissen fundoplication for GERD and the occurrence of postoperative complications,and to evaluate the clinical value of PECC,so as to provide more references for the endoscopic treatment of GERD.Research methods1.Study subjects: the study subjects were GERD patients who visited the department of gastroenterology and general surgery of the first affiliated hospital of henan university from October 2017 to May 2019.The general clinical data of these patients were collected,and the inclusion criteria and exclusion criteria were used for induction,analysis and screening.Finally,74 patients were included,of whom 42 received PECC treatment(PECC group)and 32 received laparoscopic Nissen fundoplication surgery(Nissen group).2.Data collection: the medical history of the selected patients was reviewed in detail,and the general clinical data,operation time,hospital stay,previous medical history and preoperative gerd-q score,LESP and De Meester score were recorded.Gerd-q score was calculated again 6 months after the operation,and 24-hour esophageal PH monitoring and high-resolution esophageal pressure measurement were reviewed.The two groups of patients were compared and analyzed in terms of the operation situation,the changes of various indexes before and after the operation,the evaluation of the curative effect and the occurrence of postoperative complications.3.Statistical methods: All data were statistically analyzed using SPSS25.0 software package.The measurement data were expressed as the standard deviation of mean score(x score s)and t test was used.The enumeration data were tested by X~2,and P<0.05 was considered statistically significant.Result1.There was no statistical difference in the length of hospital stay between the two groups(P=0.17),and the operation time and intraoperative blood loss of the PECC group were significantly lower than those of the Nissen group(P < 0.05).2.Gerd-q score and De Meester score 6 months after surgery in both groups were significantly lower than those before surgery,and LESP was significantly higher than that before surgery,withstatistically significant differences(P < 0.05).3.Six months after the operation,26 patients(61.9%)and 24 patients(75.0%)in PECC group and Nissen group returned to normal esophageal mucosa.4.The total effective rates of the PECC group and the Nissen group were 85.7% and 96.9%,respectively,among which 47.6% and 75.0% were clinically cured.The total effective rate of Nissen group was slightly higher than that of PECC group,but the difference was not statistically significant(P=0.100).5.Postoperative dysphagia occurred in 4 patients(12.5%)in the Nissen group,which was significantly higher than that in the PECC group(1,2.38%),with statistically significant difference(P <0.05).ConclusionFrom the comparison results,PECC is generally a safe,effective and less complication endoscopic minimally invasive treatment technique.Although the total effective rate of this endoscopic technique may be slightly lower than that of laparoscopic Nissen fundoplication(the difference is not statistically significant),it has little effect on the normal anatomical structure of esophagus and gastric fundus,and can significantly improve the symptoms of GERD while reducing postoperative complications,so it does not hinder the wide clinical application of this endoscopic technique.GERD patients within the scope of its indications can give priority to PECC treatment.