Subscribe to RSS
DOI: 10.1055/a-1369-9732
Alternative operative Verfahren zur Behandlung der gastroösophagealen Refluxerkrankung
Alternative Surgical Anti-Reflux ProceduresZusammenfassung
Das Versagen der medikamentösen Therapie bei mehr als 30% der Patienten mit gastroösophagealer Refluxerkrankung (GERD) wie auch zunehmende Bedenken bez. einer säurehemmenden Dauertherapie haben zu einer neuen Fokussierung auf chirurgische Antirefluxtherapien geführt. Unter den Sphinkteraugmentationsverfahren haben die beiden laparoskopischen Verfahren, die magnetische (LINX) und die elektrische (EndoStim), eine breitere Anwendung gefunden. Die magnetische Sphinkteraugmentation stellte eine sehr sichere (Komplikationsrate 0,1% und Reoperationsrate 3,4%) Methode dar, die sowohl zu signifikanten Verbesserungen der subjektiven (GERD-HRQL-Verbesserung 19,9 auf 4,1; p = 0,001) als auch objektiven GERD-Erfolgsparameter (79% PPI-Freiheit und 89% Normalisierung der Säureexposition im distalen Ösophagus) führt. Die elektrische Sphinkteraugmentation hat erste vielversprechende Kurzzeitergebnisse in geringen Patientenanzahlen gezeigt (92% subjektive Beschwerdeverbesserung). Ein Vergleich zum operativen Goldstandard der laparoskopischen Fundoplikation ist bei beiden Methoden ausständig. Alternative, laparoskopische Antirefluxmethoden stellen eine potenzielle Alternative zur laparoskopischen Fundoplikation dar.
Abstract
Patient satisfaction when treated with acid-suppressing medication for chronic GERD disease is less than 70%. Surgical standardisation, centralisation, improved awareness of patient selection and new surgical methods have stimulated interest in surgical reflux therapy in recent years. Magnetic sphincter augmentation (MSA) seems to be a safe alternative to laparoscopic fundoplication, with reported complication rates of 0.1% and reoperation rates of 3.4% and is also effective (GERD-HRQL improvement from 19.9 to 4.1, p = 0.001 as well PPI cessation and pH normalisation in 79 and 89% of patients, respectively). Electric sphincter augmentation shows promising short-term results in small patient cohorts (92% symptomatic improvement). However, randomised controlled studies comparing these new techniques to the “gold standard” of laparoscopic fundoplication are still missing.
Publication History
Article published online:
13 April 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Dent J, El-Serag HB, Wallander MA. et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005; 54: 710-717 doi:10.1136/gut.2004.051821
- 2 Nikolic M, Schwameis K, Kristo I. et al. Ineffective Esophageal Motility in Patients with GERD is no Contraindication for Nissen Fundoplication. World J Surg 2020; 44: 186-193 doi:10.1007/s00268-019-05229-y
- 3 Nikolic M, Schwameis K, Paireder M. et al. Tailored modern GERD therapy – steps towards the development of an aid to guide personalized anti-reflux surgery. Sci Rep 2019; 9: 19174 doi:10.1038/s41598-019-55510-2
- 4 Kristo I, Paireder M, Jomrich G. et al. Modern Esophageal Function Testing and Gastroesophageal Reflux Disease in Morbidly Obese Patients. Obes Surg 2019; 29: 3536-3541 doi:10.1007/s11695-019-04020-1
- 5 Yassi R, Cheng LK, Rajagopal V. et al. Modeling of the mechanical function of the human gastroesophageal junction using an anatomically realistic three-dimensional model. J Biomech 2009; 42: 1604-1609 doi:10.1016/j.jbiomech.2009.04.041
- 6 Warren HF, Louie BE, Farivar AS. et al. Manometric Changes to the Lower Esophageal Sphincter After Magnetic Sphincter Augmentation in Patients With Chronic Gastroesophageal Reflux Disease. Ann Surg 2017; 266: 99-104 doi:10.1097/SLA.0000000000001935
- 7 Campos GM, Peters JH, DeMeester TR. et al. The pattern of esophageal acid exposure in gastroesophageal reflux disease influences the severity of the disease. Arch Surg 1999; 134: 882-887 discussion 887–888 doi:10.1001/archsurg.134.8.882
- 8 Bonavina L, Saino G, Lipham JC. et al. LINX® Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux. Therap Adv Gastroenterol 2013; 6: 261-268 doi:10.1177/1756283X13486311
- 9 Bell R, Lipham J, Louie B. et al. Laparoscopic magnetic sphincter augmentation versus double-dose proton pump inhibitors for management of moderate-to-severe regurgitation in GERD: a randomized controlled trial. Gastrointest Endosc 2019; 89: 14-22.e1 doi:10.1016/j.gie.2018.07.007
- 10 Bell R, Lipham J, Louie BE. et al. Magnetic Sphincter Augmentation Superior to Proton Pump Inhibitors for Regurgitation in a 1-Year Randomized Trial. Clin Gastroenterol Hepatol 2020; 18: 1736-1743.e2 doi:10.1016/j.cgh.2019.08.056
- 11 Louie BE, Smith CD, Smith CC. et al. Objective Evidence of Reflux Control After Magnetic Sphincter Augmentation: One Year Results From a Post Approval Study. Ann Surg 2019; 270: 302-308 doi:10.1097/SLA.0000000000002789
- 12 Schwameis K, Nikolic M, Castellano DGM. et al. Crural Closure improves Outcomes of Magnetic Sphincter Augmentation in GERD patients with Hiatal Hernia. Sci Rep 2018; 8: 7319 doi:10.1038/s41598-018-24322-1
- 13 Schwameis K, Nikolic M, Morales Castellano DG. et al. Results of Magnetic Sphincter Augmentation for Gastroesophageal Reflux Disease. World J Surg 2018; 42: 3263-3269 doi:10.1007/s00268-018-4608-8
- 14 Aiolfi A, Asti E, Bernardi D. et al. Early results of magnetic sphincter augmentation versus fundoplication for gastroesophageal reflux disease: Systematic review and meta-analysis. Int J Surg 2018; 52: 82-88 doi:10.1016/j.ijsu.2018.02.041
- 15 Ganz RA, Peters JH, Horgan S. Esophageal sphincter device for gastroesophageal reflux disease. N Engl J Med 2013; 368: 2039-2040 doi:10.1056/NEJMc1303656
- 16 Lipham JC, Taiganides PA, Louie BE. et al. Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease. Dis Esophagus 2015; 28: 305-311 doi:10.1111/dote.12199
- 17 Alicuben ET, Bell RCW, Jobe BA. et al. Worldwide Experience with Erosion of the Magnetic Sphincter Augmentation Device. J Gastrointest Surg 2018; 22: 1442-1447 doi:10.1007/s11605-018-3775-0
- 18 Riva CG, Siboni S, Sozzi M. et al. High-resolution manometry findings after Linx procedure for gastro-esophageal reflux disease. Neurogastroenterol Motil 2020; 32: e13750 doi:10.1111/nmo.13750
- 19 Ferrari D, Asti E, Lazzari V. et al. Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease. Sci Rep 2020; 10: 13753 doi:10.1038/s41598-020-70742-3
- 20 Dunn CP, Henning JC, Sterris JA. et al. Regression of Barrettʼs esophagus after magnetic sphincter augmentation: intermediate-term results. Surg Endosc 2020;
- 21 Dominguez-Profeta R, Cheverie JN, Blitzer RR. et al. More beads, more peristaltic reserve, better outcomes: factors predicting postoperative dysphagia after magnetic sphincter augmentation. Surg Endosc 2020;
- 22 Paireder M, Kristo I, Asari R. et al. Electrical lower esophageal sphincter augmentation in patients with GERD and severe ineffective esophageal motility-a safety and efficacy study. Surg Endosc 2019; 33: 3623-3628 doi:10.1007/s00464-018-06649-y
- 23 Rieder E, Paireder M, Kristo I. et al. Electrical Stimulation of the Lower Esophageal Sphincter to Treat Gastroesophageal Reflux After POEM. Surg Innov 2018; 25: 346-349 doi:10.1177/1553350618768129
- 24 Rieder E, Riegler M, Simic AP. et al. Alternative therapies for GERD: a way to personalized antireflux surgery. Ann N Y Acad Sci 2018; 1434: 360-369 doi:10.1111/nyas.13851
- 25 Bjelović M, Harsányi L, Altorjay A. et al. Non-active implantable device treating acid reflux with a new dynamic treatment approach: 1-year results: RefluxStop™ device; a new method in acid reflux surgery obtaining CE mark. BMC Surg 2020; 20: 159 doi:10.1186/s12893-020-00794-9