目的 随访研究内镜下微量射频技术治疗胃食管反流病的5年疗效。方法 对接受微量射频治疗的难治性胃食管反流病患者进行随访研究,选择治疗前、治疗后1年、治疗后5年三个时间点,对胃食管反流症状积分(GERD-HRQL)、症状控制满意度、药物使用情况进行临床观察。结果 微量射频治疗后患者胃食管反流症状发作明显减轻,GERD-HRQL积分由治疗前的25.6±9.0,降至8.7±3.4(治疗后5年,P<0.01);烧心积分由治疗前的3.3±1.3,降至1.3±1.0(治疗后5年,P<0.05);患者对症状控制满意率由治疗前的31.1%升至71.6%,满意度积分由治疗前的1.4升至3.8(P<0.01)。治疗前全部患者需要使用质子泵抑制药(PPI)PPI控制症状,治疗后5年,70.1%患者不需要服用PPI。结论 微量射频治疗技术可以显著改善胃食管反流症状、提高患者对治疗的满意度、显著减少PPI的用量,是治疗难治性胃食管反流病的有效方法。
Abstract
Objective To evaluate the symptom control and medication changes after the Stretta procedure with gastroesophageal reflux disease (GERD) during a 5-year follow-up period. Methods We evaluated GERD-health-related quality of life, satisfaction and medication use at baseline and 12 and 60 months after treatment. Results Significant changes in symptoms of GERD, the mean GERD-HRQL score was 25.6 (baseline),and 8.7(60 months,P<0.01).The mean heartburn score was 3.3 (baseline),and 1.3(60 months,P<0.05). The percentage of patients with satisfactory GERD control improved from 31.1% at baseline to 71.6% after treatment, and patient satisfaction improved from 1.4 at baseline to 3.8 at 60 months (P<0.01). Medication usage decreased significantly from 100% of patients on PPI therapy at baseline to 70.1% at 60 months. Conclusions The experience with Stretta procedure confirms that it is well tolerated, safe, effective, and durable in the treatment of GERD. It produces significant improvements in symptom control and and decreased medication usage during a 5-year period follow-up.
关键词
胃食管反流病 /
Stretta治疗 /
微量射频
Key words
gastroesophageal reflux disease /
Stretta procedure /
radiofrequency
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Wiklund I. Review of the quality of life and burden of illness in gastroesophageal reflux disease[J]. Dig Dis,2004,22(2):108-114.
[2] Chen D, Barber C, McLoughlin P, et al. Systematic review of endoscopic treatments for gastro-oesophageal reflux disease[J]. Br J Surg, 2009,96(2):128-136.
[3] Spicak J. Treatment of gastroesophageal reflux disease: endoscopic aspects[J]. Dig Dis,2007,25(3):183-187.
[4] Jafri S M, Arora G, Triadafilopoulos G. What is left of the endoscopic antireflux devices[J]? Curr Opin Gastroenterol,2009,25(4):352-357.
[5] 刘海峰.微量射频技术治疗胃食管反流病[J]. 武警医学,2010,21(6):461-466.
[6] Velanovich V. Comparison of symptomatic and quality of outcomes of laparoscopic versus open antireflux surgery[J].Surgery,1999,12(4):782-789.
[7] Carlsson R, Dent J, Bolling-Sternevald E, et al. The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease[J]. Scand J Gastroenterol,1998,33(10):1023 -1029.
[8] Franciosa M,Mashimo H. Stretta radiofrequency treatment for GERD: a safe and effective modality [J]. Am J Gastroenterol, 2013,108(10):1654-1655.
[9] Higuchi K, Fujiwara Y, Okazaki H, et al. Feasibility, safety, and efficacy of the Stretta procedure in Japanese patients with gastroesophageal reflux disease: first report from Asia[J]. J Gastroenterol, 2007,42(3):205-210.
[10] Richards W O. Is the Stretta procedure safe and effective for the long-term control of symptoms in patients with refractory GERD?[J]. Nat Clin Pract Gastroenterol Hepatol,2007,4(12):654-655.
[11] Arts J, Bisschops R, Blondeau K, et al. A double-blind sham-controlled study of the effect of radiofrequency energy on symptoms and distensibility of the gastroesophageal junction in GERD[J]. Am J Gastroenterol,2012,107(2):222-230.
[12] Triadafilopoulos G, Dibaise J K, Nostrant T T, et al. Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD[J]. Gastrointest Endosc,2001,53(4):407-415.
[13] Tam W E, Schoeman M N, Zhang Q, et al. Delivery of radiofrequency energy to the lower oesophageal sphincter and gastric cardia inhibits transient lower oesophageal sphincter relaxations and gastro-oesophageal reflux in patients with reflux disease[J]. Gut, 2003, 52(4):479-485.
[14] Auyang E D , Carter P , Rauth T, et al. SAGES clinical spotlight review: endoluminal treatments for gastroesophageal reflux disease (GERD) [J]. Surg Endosc,2013,27(8):2658-2672.
[15] Perry K A , Banerjee A , Melvin W S . Radiofrequency energy delivery to the lower esophageal sphincter reduces esophageal acid exposure and improves GERD symptoms: a systematic review and meta-analysis[J]. Surg Laparosc Endosc Percutan Tech,2012, 22 (4):283-288.
[16] Aziz A M, El-Khayat H R, Sadek A,et al. A prospective randomized trial of sham, single-dose Stretta, and double-dose Stretta for thetreatment of gastroesophageal reflux disease [J]. Surg Endosc,2010,24 (4):818- 825.
[17] Meier P N, Nietzschmann T, Akin I, et al. Improvement of objective GERD parameters after radiofrequency energy delivery: a European study[J]. Scand J Gastroenterol,2007, 42(8):911-916
[18] Noar M D, Lotfi-Emran S. Sustained improvement in symptoms of GERD and antisecretory drug use: 4-year follow-up of the Stretta procedure[J]. Gastrointest Endosc,2007,65(3):367-372.
[19] Triadafilopoulos G, Dibasie J K, Nostrant T T, et al. The Stretta procedure for the treatment of GERD: 6 and 12month follow-up of the U.S.open label trial[J]. Gastrointest Endosc, 2002,55(2):149-156.