胃食管反流病的抗反流黏膜干预:内镜下抗反流治疗的新视野。

IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Digestion Pub Date : 2025-09-15 DOI:10.1159/000547947
Haruhiro Inoue, Mayo Tanabe, Kazuki Yamamoto, Yohei Nishikawa, Kei Ushikubo, Ippei Tanaka, Kaori Owada, Manabu Onimaru, Takayoshi Ito, Noboru Yokoyama, Stefan Seewald
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引用次数: 0

摘要

抗反流粘膜(ARM)干预扩大了胃食管反流疾病的治疗范围,超出了药物治疗和手术治疗。本文回顾了从抗反流粘膜切除术(ARMS)和抗反流粘膜消融(ARMA)到最近发展的抗反流粘膜成形术(ARMP)和ARMP带瓣膜(腋窝)的演变。总的来说,现有的队列研究和系统评价表明,临床缓解率为70-82%,高达55%的病例停止使用质子泵抑制剂。最常见的不良事件是短暂性吞咽困难(约11%)和术后出血(约5%),这两种情况均可在内镜下控制。在ARMP中直接闭合缺损缩短了症状缓解的间隔,几乎消除了延迟出血,而技术改进,如角度增强器和反粘膜切口,改善了通路和张力管理。在选择ARM干预技术时,我们建议ARMP作为naïve解剖学的一线选择,保留ARMA用于重做或术后粘膜下纤维化限制应用的情况。正在进行的试验正在评估5年以上的耐久性,结合吊带和扣肌纤维的全层缝合的作用,以及在肥胖或食管旁疝人群中的应用。未来的研究重点包括标准化溃疡尺寸以优化收缩,改进患者报告的结果测量,以及澄清与眼底复制和磁性括约肌增强相关的成本效益。总之,ARM干预提供了一系列灵活、微创的解决方案,可以根据个体解剖和生理特征进行定制,有可能弥合长期抑酸和手术之间的治疗差距。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anti-reflux mucosal intervention for gastroesophageal reflux disease: a new horizon of endoscopic anti-reflux therapy.

Anti-reflux mucosal (ARM) interventions have expanded the therapeutic spectrum for gastroesophageal reflux disease beyond pharmacologic therapy and surgery. This narrative review traces the evolution from anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA) to the more recently developed anti-reflux mucoplasty (ARMP) and ARMP with valve (ARMPV). Collectively, the available cohort studies and systematic reviews indicate a clinical response rate of 70-82%, with proton-pump inhibitor discontinuation achieved in up to 55% of cases. The most common adverse events are transient dysphagia (~11%) and post-procedural bleeding (~5%), both of which are manageable endoscopically. Direct defect closure in ARMP shortens the interval to symptom relief and virtually eliminates delayed bleeding, while technical refinements such as the angle booster and counter-mucosal incision have improved access and tension management. When selecting among ARM intervention techniques, we propose ARMP as the first-line option in naïve anatomy, reserving ARMA for redo or post-surgical settings where submucosal fibrosis limits application. Ongoing trials are assessing durability beyond five years, the role of full-thickness suturing that incorporates sling- and clasp-muscle fibers, and applications in bariatric or para-esophageal hernia populations. Future research priorities include standardizing ulcer dimensions to optimize shrinkage, refining patient-reported outcome measures, and clarifying cost-effectiveness relative to fundoplication and magnetic sphincter augmentation. In summary, ARM interventions offers a spectrum of flexible, minimally invasive solutions that can be tailored to individual anatomic and physiological profiles, potentially bridging the treatment gap between long-term acid suppression and surgery.

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来源期刊
Digestion
Digestion 医学-胃肠肝病学
CiteScore
7.90
自引率
0.00%
发文量
39
审稿时长
6-12 weeks
期刊介绍: ''Digestion'' concentrates on clinical research reports: in addition to editorials and reviews, the journal features sections on Stomach/Esophagus, Bowel, Neuro-Gastroenterology, Liver/Bile, Pancreas, Metabolism/Nutrition and Gastrointestinal Oncology. Papers cover physiology in humans, metabolic studies and clinical work on the etiology, diagnosis, and therapy of human diseases. It is thus especially cut out for gastroenterologists employed in hospitals and outpatient units. Moreover, the journal''s coverage of studies on the metabolism and effects of therapeutic drugs carries considerable value for clinicians and investigators beyond the immediate field of gastroenterology.
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