Transoral incisionless fundoplication with or without hiatal hernia repair for gastroesophageal reflux disease after peroral endoscopic myotomy.

Autor:	DeWitt JM; Gastroenterology and Hepatology, Indiana University Health Inc, Indianapolis, United States., Al-Haddad M; Gastroenterology and Hepatology, Indiana University Health Inc, Indianapolis, United States., Stainko S; Gastroenterology and Hepatology, Indiana University Health Inc, Indianapolis, United States., Perkins A; Biostatistics, Indiana University Health Inc, Indianapolis, United States., Fatima H; Gastroenterology and Hepatology, Indiana University Health Inc, Indianapolis, United States., Ceppa DP; Gastroenterology and Hepatology, Indiana University Health Inc, Indianapolis, United States., Birdas TJ; Department of Surgery, Division of Cardiothoracic Surgery, Indiana University Health Inc, Indianapolis, United States.
Jazyk:	angličtina
Zdroj:	Endoscopy international open [Endosc Int Open] 2024 Jan 05; Vol. 12 (1), pp. E43-E49. Date of Electronic Publication: 2024 Jan 05 (Print Publication: 2024).
DOI:	10.1055/a-2215-3415
Abstrakt:	Background and study aims Gastroesophageal reflux disease (GERD) following peroral endoscopic myotomy (POEM) occurs in 40% to 60% of patients. There are limited data evaluating antireflux surgery or transoral incisionless fundoplication (TIF) for refractory post-POEM GERD. Patients and methods In a single-center prospective cohort study, consecutive patients with medically refractory post-POEM regurgitation and/or GERD treated with TIF or combined laparoscopic hernia repair and TIF (cTIF) were evaluated. Baseline evaluation: GERD-Health Related Quality of Life (GERD-HQRL) and Reflux Symptom Questionnaire 7-day recall (RESQ-7) questionnaires, EGD, high-resolution manometry (HRM), 48-hour pH test off proton pump inhibitors (PPIs) and impedance planimetry of the esophagogastric junction (EGJ) to calculate the diameter distensibility index (EGJ-DI). A PPI was taken twice daily for 2 weeks after TIF and restarted later if required. Patients returned 9 to 12 months after treatment when all preoperative studies were repeated. Quality of life, pH studies and EGJ metrics before and after antireflux surgery were compared. Results Seventeen patients underwent TIF (n=2, 12%) or cTIF (n=15, 88%) a mean 25±15 months after POEM. At follow-up a mean of 9±1 months after TIF/cTIF, patients required less frequent daily PPIs (n=0.001), were more satisfied (P=0.008), had improved GERD-HQRL (P=0.001), less intensity and frequency of GERD (P=0.001) and fewer reflux episodes (P=0.04) by pH testing. There was no change in EGJ-DI, EGJ diameter, integrated relaxation pressure, % total time pH <4, or DeMeester score. Conclusions TIF and cTIF for difficult-to-control post-POEM GERD appear safe, decrease PPI use and reflux episodes, and improve QOL without significant change in IRP, EGJ compliance, diameter or esophageal acid exposure time. Competing Interests: Conflict of Interest John DeWitt (consultant: Boston Scientific, Inc., APM Therapeutics, Inc, Vyaire Medical, Inc; Grant Support: Vyaire Medical, Inc.); Sarah Stainko (none); Anthony Perkins (none); Mohammad A. Al-Haddad (Consultant: Boston Scientific, Inc Grant support: Cook Medical, Amplified Sciences, Inc, Creatics, LLC); Thomas J. Birdas (none); Mimi Ceppa (none); Hala Fatima (none) (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
Databáze:	MEDLINE
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