A novel endoscopic submucosal dissection technique for proton pump inhibitor-refractory gastroesophageal reflux disease.
OBJECTIVE
Although drug treatment is the usual first-line therapy for gastroesophageal reflux disease (GERD), not all patients receive satisfactory relief from drug therapy, alone. We developed an endoscopic fundoplication technique using endoscopic submucosal dissection (ESD); the technique is referred to as ESD for GERD (ESD-G). This study investigated the safety and efficacy of this novel technique in patients with drug-refractory GERD.


METHODS
ESD-G narrows the hiatal opening through ESD of the esophagogastric junction (EGJ) mucosa. For safety reasons, the range of mucosal resection was limited to half (1/2 or 1/4 +1/4) of the circumference of the EGJ lumen. ESD-G was performed on 13 patients with proton pump inhibitor (PPI)-refractory GERD. GERD symptoms, PPI dose, and 24-h esophageal pH monitoring results were compared before and 6 months after the procedure. Results. In 12 cases, symptoms significantly improved after ESD-G. Five patients demonstrated improved esophagitis, three were able to discontinue PPI therapy, and three were able to reduce their PPI dosage following surgery. The esophageal pH <4 holding time ratio was also decreased after ESD-G. Conclusions. ESD-G may be useful for PPI-refractory GERD patients.
Second Department of Internal Medicine, Osaka Medical College , Takatsuki, Osaka , Japan.
Kazuhiro
K
Ota
Toshihisa
T
Takeuchi
Satoshi
S
Harada
Shoko
S
Edogawa
Yuichi
Y
Kojima
Takuya
T
Inoue
Kazuhide
K
Higuchi
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors
endoscopic submucosal dissection; gastroesophageal reflux disease; proton pump inhibitor