Endoskopische transmurale Gastroplicatio in der Refluxtherapie: Eine wirksame Therapie?

Zusammenfassung

Sodbrennen, das am häufigsten vorkommende Symptom der GERD, tritt bei ca. 10-20 % der US- und westeuropäischen Bevölkerung auf. Die PPI-Therapie muss meist lebenslang durchgeführt werden, da die Symptome nach Absetzen der PPI fast immer rezidivieren. In den letzten Jahren wurden verschiedene Techniken zur endoskopischen Antirefluxtherapie entwickelt. Neben endoskopischen Nahttechniken wurden Injektions- / Implantationsverfahren von Biopolymeren und die Radiofrequenztherapie erprobt. Die meisten dieser Techniken sind aufgrund mangelnder Wirksamkeit oder schwerwiegender Nebenwirkungen wieder aufgegeben worden. Da es bei endoluminalen Nahtverfahren der 1. Generation häufig zu Nahtverlusten kam, wurde das transmurale Nahtsystem Plicator™ entwickelt. In einer prospektiv-randomisierten, Plazebo-kontrollierten-Studie konnte eine signifikante Verbesserung hinsichtlich Beschwerden, Medikamentenverbrauch und pH-Metriedaten gezeigt werden. Technische Weiterentwicklungen wie die Verwendung von 2 Nähten werden zur Zeit in Studien evaluiert.

Abstract

Heartburn, the most common symptom associated with GERD, occurs in 10-20 % of the US and western European population. Life long PPI therapy for GERD is often required since symptoms typically recur once therapy has been discontinued. Recently a couple of endoscopic antireflux procedures have been developed. These techniques include injection or implantation of biopolymers and application of radiofrequency. Most of the techniques have been abandoned due to lack of long-term efficacy or serious side effects. Since first generation endoluminal suturing techniques showed insufficient durability, due to suture loss, the transmural plication technique Plicator™ was developed. In a prospective-randomized, sham-controlled trial the Plicator proved superiority concerning reflux symptoms, medication use and esophageal acid exposure. Further technical improvements like the use of 2 sutures are currently investigated.

Schlüsselwörter

endoskopische Antirefluxtherapie - GERD - Plicator™ - endoskopische Fundoplicatio

Key words

endoscopic antireflux therapy - GERD - Plicator™ - endoscopic Fundoplicatio

Literatur

• 1 Armstrong D, Emde C, Blum A L. et al . Diagnostic assessment of gastroesophageal reflux disease: what is possible vs. what is practical.  Hepatogastroenterology. 1992;  39 3-13
• 2 Allescher H D. Diagnosis of gastroesophageal reflux.  Schweiz Rundsch Med Prax. 2002;  91 779-790
• 3 Altenbach T, Crockett S, Gerson L B. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach.  Arch Intern Med. 2006;  166 965-971
• 4 Bredenoord A J, Weusten B L, Smout A J. et al . Addition of esophageal impedance monitoring to pH monitoring increases the yield of symptom association analysis in patients off PPI therapy.  Am J Gastroenterol. 2006;  101 453-459
• 5 Corley D A, Katz P, Wolfe M M. et al . Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial.  Gastroenterology. 2003;  125 668-676
• 6 Deviere J, Costamagna G, Schumacher B. et al . Nonresorbable copolymer implantation for gastroesophageal reflux disease: a randomized sham-controlled multicenter trial.  Gastroenterology. 2005;  128 532-540
• 7 Fuchs K H, Feussner H. Laparoscopic fundoplication. Indications and results.  Internist. 2003;  44 36-42
• 8 Haber G, Sakai P, Lembo A. et al . The plicator procedure for the treatment of GERD: 12-month multicenter results.  Gastrointest Endosc. 2005;  61 AB 96
• 9 Hartmann D, Kudis V, Schilling D. et al . Course of Erosive Gastroesophageal Reflux Disease (ERD) - a prospective examination under therapeutic daily life conditions with a mean follow-up of 6.5 years.  Z Gastroenterol. 2006;  44 1039-1042
• 10 Hogan W J. Clinical trials evaluating endoscopic GERD treatments: is it time for a moratorium on the clinical use of these procedures?.  Am J Gastroenterol. 2006;  101 437-439
• 11 Kawamura O, Aslam M, Shaker R. et al . Physical and pH properties of gastro-esophagopharyngeal refluxate: a 24-hour simultaneous ambulatory impedance and pH monitoring study.  Am J Gastroenterol. 2004;  99 1000-1010
• 12 Klinkenberg-Knol E C, Festen H P, Meuwissen S G. Pharmacological management of gastro-oesophageal reflux disease.  Drugs. 1995;  49 695-710
• 13 Koop H. Diagnosis of gastro-esophageal reflux disease.  Schweiz Rundsch Med Prax. 2004;  93 1959-1962
• 14 Koop H, Schepp W, Hotz J. et al . Consensus conference of the DGVS on gastroesophageal reflux.  Z Gastroenterol. 2005;  43 163-194
• 15 Mainie I, Castell D O. Do we need to rethink fundoplication for patients who have failed proton-pump-inhibitor therapy?.  Nat Clin Pract Gastroenterol Hepatol. 2006;  3 2-3
• 16 Mainie I, Tutuian R, Castell D O. et al . Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication.  Br J Surg.. 2006;  ,  In press
• 17 Meining A, Bajbouj M, Schmid R M. et al . Diagnosis and therapy of weakly-acid/non-acidic gastroesophageal reflux disease.  Dtsch Med Wochenschr. 2005;  130 2266-2269
• 18 Pleskow D, Rothstein R, Lembo A. et al . Endoscopic full-thickness plication for the treatment of GERD: 12-month follow-up for the North American open-label trial.  Gastrointest Endosc. 2005;  61 643-649
• 19 Rothstein R, Filipi C, Caca K. et al . Endoscopic full-thickness plication for the treatment of gastroesophageal reflux disease: a randomized, sham-controlled trial.  Gastroenterology (United States). 2006;  131 704-712
• 20 Romagnuolo J. Endoscopic “antireflux” procedures: not yet ready for prime time.  Can J Gastroenterol. 2004;  18 573-577
• 21 Schiefke I, Mossner J, Caca K. Reflux esophagitis.  Internist. 2005;  46 315-327
• 22 Schilling D, Riemann J F. Evidence based conservative therapy of gastroesophageal reflux.  Internist. 2003;  44 21-27
• 23 Schilling D, Kiesslich R, Riemann J F. et al . Endoluminal therapy of GERD with a new endoscopic suturing device.  Gastrointest Endosc. 2005;  62 37-43
• 24 Shaheen N J. The rise and fall (and rise?) of endoscopic anti-reflux procedures.  Gastroenterology. 2006;  131 952-954
• 25 Tutuian R. Update in the diagnosis of gastroesophageal reflux disease.  J Gastrointestin Liver Dis. 2006;  15 243-247
• 26 Vakil N, van Zanten S V, Jones R. et al . The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus.  Am J Gastroenterol. 2006;  101 1900-1920
• 27 Zerbib F, Roman S, Sifrim D. et al . Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy.  Am J Gastroenterol. 2006;  101 1956-1963
• 28 Zhi X T, Kavic S M, Park A E. Management of gastroesophageal reflux disease: medications, surgery, or endoscopic therapy?.  J Long Term Eff Med Implants. 2005;  15 375-388