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

Publikationsverlauf

Artikel online veröffentlicht:
13. April 2021

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