Original Article
Feasibility of modified endoscopic anti-reflux mucosectomy for refractory gastroesophageal reflux disease with moderate hiatus hernia
Chen Lei, Zhu Zhen, Wang Lu, Zhu Haihang, Ni Xiufan, Gao Sujun
Published 2023-02-20
Cite as Chin J Dig Endosc, 2023, 40(2): 126-130. DOI: 10.3760/cma.j.cn321463-20220413-00398
Abstract
ObjectiveTo evaluate the efficiency and safety of modified endoscopic anti-reflux mucosectomy (ARMS) for refractory gastroesophageal reflux disease (rGERD) with moderate hiatus hernia.
MethodsA total of 30 patients with rGERD with moderate hiatus hernia (3-5 cm) diagnosed at the Department of Gastroenterology of Northern Jiangsu People's Hospital from June 2017 to June 2020 were randomly divided into 2/3 circumferential mucosal resection group (n=15) and 3/4 circumferential mucosal resection group (n=15) using random number table method, and received modified ARMS of the corresponding mucosal resection range. The GERD symptoms, esophagitis under endoscopy, 24 h pH results, and lower esophageal sphincter (LES) resting pressure were compared before and after the procedure. The therapeutic effect and complications of the two groups were analyzed.
ResultsIn 2/3 resection group, the GERD questionnaire scores (9.53±0.36 VS 11.93±0.57, t=6.874, P<0.001), acid exposure time (19.81%±1.72% VS 31.45%±2.78%, t=8.020, P<0.001) and the DeMeester score based on 24 h esophageal pH monitoring (40.98±4.55 VS 55.33±5.65, t=6.408, P<0.001) at 6 months after the treatment showed a significant reduction compared with those before. In 3/4 resection group, the GERD questionnaire scores (9.0±0.57 VS 12.47±0.68, t=8.650, P<0.001), acid exposure time (20.07%±2.19% VS 29.96%±3.00%, t=7.444, P<0.001) and the DeMeester score (33.67±3.47 VS 51.17±6.03, t=4.973, P<0.001) at 6 months after the treatment were lower than those before. There was no significant difference in the GERD questionnaire scores (t=0.790, P=0.436), acid exposure time (t=0.093, P=0.926) or the DeMeester score (t=1.278, P=0.212) between the two groups at 6 months after treatment. In the two groups, there was no significant difference in the ratio of esophagitis grade C and D (10/15 VS 5/15, χ2=3.894, P=0.063; 8/15 VS 4/15, χ2=2.778, P=0.125) or LES resting pressure [3.29 (2.66,8.29) mmHg VS 3.98 (3.67,9.43) mmHg, P=0.334;5.78 (1.9,8.46) mmHg VS 5.88 (3.28,8.99) mmHg, P=0.125] before and after the treatment. No postoperative delayed bleeding or perforation was observed. The incidence of postoperative esophageal stenosis of 2/3 resection group was lower than that of the other group (1/15 VS 6/15, χ2=4.658, P=0.021).
ConclusionModified ARMS is effective for controlling reflux symptoms and esophageal acid exposure in rGRED patients with moderate hiatus hernia (3-5 cm), but cannot significantly increase the postoperative resting pressure of LES. Compared with 3/4 circumferential mucosal resection, 2/3 circumferential mucosal resection can reduce the incidence of postoperative esophageal stenosis.
Key words:
Gastroesophageal reflux; Hernia, hiatal; Endoscopic mucosal resection
Contributor Information
Chen Lei
Department of Gastroenterology, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou 225001, China
Zhu Zhen
Department of Gastroenterology, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou 225001, China
Wang Lu
Department of Gastroenterology, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou 225001, China
Zhu Haihang
Department of Gastroenterology, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou 225001, China
Ni Xiufan
Department of Gastroenterology, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou 225001, China
Gao Sujun
Department of Gastroenterology, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou 225001, China
