内镜技术治疗胃食管反流病的研究进展

Advance in endoscopic technology for gastroesophageal reflux disease

关键词:  胃食管反流病  胃食管阀瓣  食管下段括约肌  内镜射频消融术  内镜下黏膜切除术

Key words:  gastroesophageal reflux disease  gastroesophageal flap valve  lower esophageal sphincter  endoscopic radiofrequency ablation  anti-reflux mucosectomy

摘要:

胃食管反流病（gastroesophageal reflux disease，GERD）在亚洲的发病率逐年升高，严重影响患者的生活质量。质子泵抑制剂（proton pump inhibitor，PPI）一直被公认是治疗GERD的首选内科药物。约有30%的患者属于PPI难治性GERD，胃底折叠术是治疗GERD的首选术式，但手术创伤较大，术后并发症较多。随着内镜技术的发展，目前内镜下微创技术通过改善抗反流屏障成为治疗GERD的新思路。本文主要就内镜技术调节食管下段括约肌收缩功能，改善His角角度，修复胃食管阀瓣紧密性三个方面进行综述，主要包括射频消融技术，内镜下胃底折叠术，内镜下黏膜切除术。

Abstract:

Gastroesophageal reflux disease (GERD) interferes with the quality of patients' lives and the morbidity are increasing in Asia. Proton pump inhibitor (PPI) is the mainstay of treatment for GERD. For PPI-refractory patients, fundoplication was considered as the principal surgery for GERD. Recently, with the development of endoscopic technology, Endoscopic surgery can repair the anti-reflux barrier with minimal invasiveness, which is considered as a new treatment for GERD. We mainly reviewed several endoscopic anti-reflux technology by strengthening the contractive function of lower esophageal sphincter, modifying the His angle and repairing the compactness of gastroesophageal flap valve, including radiofrequency ablation, endoscopic fundoplication and anti-reflux mucosectomy (ARMS).