Aktueller Stand bei den endoskopischen Therapieverfahren der GERD (Endoplikation): GERDX, MUSE, EsophyX

Zusammenfassung

Die gastroösophageale Refluxerkrankung (GERD) beeinträchtigt durch ihre Symptome die Lebensqualität betroffener Patienten teils beträchtlich. Im Laufe der letzten Jahrzehnte zeigt die GERD eine zunehmende Prävalenz weltweit. Zugrunde liegt der GERD meist ein insuffizientes, weil strukturell defektes Ventil zwischen Magen und Speiseröhre. Zur Behandlung von GERD haben sich bis heute die Medikamentengruppe der Protonenpumpenhemmer (PPI) als konservative, rein symptomatische Therapie und die laparoskopische Fundoplikation (LF) in ihren Ausführungsvarianten zur Behebung der Ursache etabliert. In den letzten 2 Jahrzehnten wurden zunehmend neue Verfahren als Therapieoption entwickelt. Die Endoskopie verfolgt hierbei unterschiedliche Ansätze: Augmentierung mittels Injektionsverfahren, Stabilisierung des unteren Ösophagussphinkters mittels Radiofrequenzablation (RFA, Stretta-Prozedur) und Mukosaresektion (ARMS) bzw. Rekonstruktion des Ventilapparates mit Klammernahtgeräten (GERDX, MUSE, EsophyX). Abgesehen von der RFA haben sich vor allem die Klammerverfahren durchgesetzt. Die kurzfristigen Ergebnisse sind vielversprechend, Langzeitresultate jedoch noch kaum verfügbar. Auch randomisierte Vergleichsstudien zur LF sind rar.

Abstract

Gastroesophageal reflux disease (GERD) has been a problem for patients throughout in recent decades worldwide and its prevalence is increasing. Until 20 years ago, the established treatments were the proton pump inhibitors (PPI) and varieties of laparoscopic fundoplication (LF). Increasing experience with endoscopy and knowledge of the oesophagogastric junction (EGJ) has led to new options in the treatment of GERD. However, promising short term effects have been found with radiofrequency ablation (RFA, Stretta device), endoscopic mucosal resection (ARMS) for induction of scar tissue at the lower oesophageal sphincter (LES) and endoscopic suture devices like GERDX, MUSE and EsophyX to reconstruct the flap valve at the EGJ. Long-term follow-up data and randomised controlled studies in comparison to LF are still rare.

Schlüsselwörter

endoskopische Chirurgie - gastroösophageale Refluxkrankheit - Endoplikation - TIF - GERDX

Key words

endoscopic surgery - gastroesophageal reflux disease (GERD) - endoplication - GERDX - TIF

Publication History

Article published online:
13 April 2021

• Literatur

• 1 Vakil N, van Zanten SV, Kahrilas P. et al. The Montreal definition and classification of gastroesophageal reflux disease (GERD) – a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900-1920 doi:10.1111/j.1572-0241.2006.00630.x
• 2 Dent J, El-Serag HB, Wallander MA. et al. Epidemiology of gastroesophageal reflux disease: a systematic review. Gut 2005; 54: 710-717 doi:10.1136/gut.2004.051821
• 3 El-Serag HB, Sweet S, Winchester CC. et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014; 63: 871-880 doi:10.1136/gutjnl-2012-304269
• 4 Mittal RK, Balaban DH. The esophagogastric junction. N Engl J Med 1997; 336: 924-932 doi:10.1056/NEJM199703273361306
• 5 Hill LD, Aye RW, Ramel S. Antireflux surgery: a surgeonʼs look. Gastroenterol Clin North Am 1990; 19: 745-775
• 6 Jobe BA, Richter JE, Hoppo T. et al. Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the Esophageal Diagnostic Advisory Panel. J Am Coll Surg 2013; 217: 586-597 doi:10.1016/j.jamcollsurg.2013.05.023
• 7 von Rahden BHA, Filser J, Germer CT. [PPI vs. fundoplication in the treatment of gastroesophageal reflux disease: results of the Cochrane meta-analysis and the LOTUS study]. Chirurg 2011; 82: 944-946 doi:10.1007/s00104-011-2157-x
• 8 Watson DI, Jamieson GG. Antireflux surgery in the laparoscopic era. Br J Surg 1998; 85: 1173-1184 doi:10.1046/j.1365-2168.1998.00829.x
• 9 Fass R, Cahn F, Scotti DJ. et al. Systematic review and meta-analysis of controlled and prospective cohort efficacy studies of endoscopic radio frequency for treatment of gastroesophageal reflux disease. Surg Endosc 2017; 31: 4865-4882 doi:10.1007/s00464-017-5431-2
• 10 Auyang ED, Carter P, Rauth T. et al. SAGES Guidelines Committee. SAGES clinical spotlight review: endoluminal treatments for gastroesophageal reflux disease (GERD). Surg Endosc 2013; 27: 2658-2672 doi:10.1007/s00464-013-3010-8
• 11 Pearl J, Pauli E, Dunkin B. et al. SAGES endoluminal treatments for GERD. Surg Endosc 2017; 31: 3783-3790 doi:10.1007/s00464-017-5639-1
• 12 Inoue H, Ito H, Ikeda H. et al. Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: a pilot study. Ann Gastroenterol 2014; 27: 346-351
• 13 Sumi K, Inoue H, Kobayashi Y. et al. Endoscopic treatment of proton pump inhibitor-refractory gastroesophageal reflux disease with anti-reflux mucosectomy: Experience of 109 cases. Dig Endosc 2020;
• 14 Hill LD, Kozarek RA, Kraemer SJ. et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc 1996; 44: 541-547 doi:10.1016/s0016-5107(96)70006-8
• 15 Pandolfino JE, Krishnan K. Do endoscopic antireflux procedures fit in the current treatment paradigm of gastroesophageal reflux disease?. Clin Gastroenterol Hepatol 2014; 12: 544-554 doi:10.1016/j.cgh.2013.06.012
• 16 Ganz RA. A Review of New Surgical and Endoscopic Therapies for Gastroesophageal Reflux Disease. Gastroenterol Hepatol (N Y) 2016; 12: 424-431
• 17 Schiefke I, Zabel-Langhennig A, Neumann S. et al. Long term failure of endoscopic gastroplication (EndoCinch). Gut 2005; 54: 752-758 doi:10.1136/gut.2004.058354
• 18 Mahmood Z, Ang YS. EndoCinch treatment for gastro-oesophageal reflux disease. Digestion 2007; 76: 241-247 doi:10.1159/000112853
• 19 Pleskow D, Rothstein R, Kozarek R. et al. Endoscopic full-thickness plication for the treatment of GERD: Five-year long-term multicenter results. Surg Endosc 2008; 22: 326-332 doi:10.1007/s00464-007-9667-0
• 20 von Renteln D, Schiefke I, Fuchs KH. et al. Endoscopic full-thickness plication for the treatment of gastroesophageal reflux disease using multiple Plicator implants: 12-month multicenter study results. Surg Endosc 2009; 23: 1866-1875 doi:10.1007/s00464-009-0490-7
• 21 Khajanchee YS, Ujiki M, Dunst CM. et al. Patient factors predictive of 24-h pH normalization following endoluminal gastroplication for GERD. Surg Endosc 2009; 23: 2525-2530 doi:10.1007/s00464-009-0448-9
• 22 Spaun G, Koch O, Emmanuel K. Vergleich von 2 Nahtgeräten zur endoskopischen Therapie der gastroösophagealen Refluxerkrankung. Endoskopie heute 2014; 27: P7 doi:10.1055/s-0034-1371042
• 23 Weitzendorfer M, Spaun GO, Antoniou SA. et al. Clinical feasibility of a new full-thickness endoscopic plication device (GERDx) for patients with GERD: results of a prospective trial. Surg Endosc 2018; 32: 2541-2549 doi:10.1007/s00464-018-6153-9
• 24 Zacherl J, Roy-Shapira A, Bonavina L. et al. Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler (MUSE) for gastroesophageal reflux disease: 6-month results from a multi-center prospective trial. Surg Endosc 2015; 29: 220-229 doi:10.1007/s00464-014-3731-3
• 25 Kim HJ, Kwon CI, Kessler WR. et al. Long-term follow-up results of endoscopic treatment of gastroesophageal reflux disease with the MUSE endoscopic stapling device. Surg Endosc 2016; 30: 3402-3408 doi:10.1007/s00464-015-4622-y
• 26 McCarty TR, Itidiare M, Njei B. et al. Efficacy of transoral incisionless fundoplication for refractory gastroesophageal reflux disease: a systematic review and meta-analysis. Endoscopy 2018; 50: 708-725 doi:10.1055/a-0576-6589
• 27 Testoni PA, Testoni S, Distefano G. et al. Transoral incisionless fundoplication with EsophyX for gastroesophageal reflux disease: clinical efficacy is maintained up to 10 years. Endosc Int Open 2019; 7: E647-E654 doi:10.1055/a-0820-2297
• 28 Trad KS, Barnes WE, Prevou ER. et al. The TEMPO trial at 5 years: Transoral fundoplication (TIF 2.0) is safe, durable, and cost-effective. Surg Innov 2018; 25: 149-157 doi:10.1177/1553350618755214
• 29 Jain D, Singhal S. Transoral incisionless fundoplication for refractory gastroesophageal reflux disease: Where do we stand?. Clin Endosc 2016; 49: 147-156 doi:10.5946/ce.2015.044
• 30 Huang X, Chen S, Zhao H. et al. Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc 2017; 31: 1032-1044 doi:10.1007/s00464-016-5111-7
• 31 Richter JE, Kumar A, Lipke S. et al. Efficacy of laparoscopic Nissen fundoplication vs. transoral incisionless fundoplication or proton pump inhibitors in patients with gastroesophageal reflux disease: a systematic review and network meta-analysis. Gastroenterology 2018; 154: 1298-1308 doi:10.1053/j.gastro.2017.12.021
• 32 Frazzoni M, Conigliaro R, Manta R. et al. Reflux parameters as modified by EsophyX or laparoscopic fundoplication in refractory GERD. Aliment Pharmacol Ther 2011; 34: 67-75 doi:10.1111/j.1365-2036.2011.04677.x
• 33 Bell RC, Kurian AA, Freeman KD. Laparoscopic anti-reflux revision surgery after transoral incisionless fundoplication is safe and effective. Surg Endosc 2015; 29: 1746-1752 doi:10.1007/s00464-014-3897-8