Revista de gastroenterologia de Mexico · 2004
[Cardias mucosa plication with endoluminal sutures by endoscopy in gastroesophageal reflux disease treatment].
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Reyes-Dorantes Angel Andrés
Аннотация
INTRODUCTION: Gastro-esophageal reflux disease is very common among general population, today's standard treatments are medical with proton pump inhibitors and laparoscopic antireflux surgery. Endoscopic gastric plication has been described recently for the treatment of this disease.
OBJECTIVE: Review recent advances of the endoscopic gastric plication procedures for the management of gastro-esophageal reflux disease and report our experience.
METHODS: Patients with symptomatic gastro-esophageal reflux disease are selected, with esophagitis A and B according to Los Angeles classification and with a De Meester score higher than 26 in 24 hour pH determination. Patients younger than 18 or older than 60 years old are excluded as well as patients with a hiatal hernia greater than 3 cm, previous esophageal or gastric surgery, associated esophageal pathology or a C or D esophagitis.
RESULTS: After this procedure the lower esophageal sphincter increases its length, nevertheless there are minimal changes in its pressure, it also diminishes esophageal acid exposure time. Most studies show improvement in symptoms and less drug requirements. In studies with greater follow up period only a minority of patients persists with a good complete response with this treatment.
CONCLUSIONS: Prospective randomized trials are needed to determine the real utility of this procedure, aside from these protocols there are no true indications to do this procedure in the general population.
OBJECTIVE: Review recent advances of the endoscopic gastric plication procedures for the management of gastro-esophageal reflux disease and report our experience.
METHODS: Patients with symptomatic gastro-esophageal reflux disease are selected, with esophagitis A and B according to Los Angeles classification and with a De Meester score higher than 26 in 24 hour pH determination. Patients younger than 18 or older than 60 years old are excluded as well as patients with a hiatal hernia greater than 3 cm, previous esophageal or gastric surgery, associated esophageal pathology or a C or D esophagitis.
RESULTS: After this procedure the lower esophageal sphincter increases its length, nevertheless there are minimal changes in its pressure, it also diminishes esophageal acid exposure time. Most studies show improvement in symptoms and less drug requirements. In studies with greater follow up period only a minority of patients persists with a good complete response with this treatment.
CONCLUSIONS: Prospective randomized trials are needed to determine the real utility of this procedure, aside from these protocols there are no true indications to do this procedure in the general population.