Endoskopische transmurale Gastroplicatio in der Refluxtherapie: Eine wirksame Therapie?

Zusammenfassung

Sodbrennen, das am häufigsten vorkommende Symptom der GERD, tritt bei ca. 10-20 % der US- und westeuropäischen Bevölkerung auf. Die PPI-Therapie muss meist lebenslang durchgeführt werden, da die Symptome nach Absetzen der PPI fast immer rezidivieren. In den letzten Jahren wurden verschiedene Techniken zur endoskopischen Antirefluxtherapie entwickelt. Neben endoskopischen Nahttechniken wurden Injektions- / Implantationsverfahren von Biopolymeren und die Radiofrequenztherapie erprobt. Die meisten dieser Techniken sind aufgrund mangelnder Wirksamkeit oder schwerwiegender Nebenwirkungen wieder aufgegeben worden. Da es bei endoluminalen Nahtverfahren der 1. Generation häufig zu Nahtverlusten kam, wurde das transmurale Nahtsystem Plicator™ entwickelt. In einer prospektiv-randomisierten, Plazebo-kontrollierten-Studie konnte eine signifikante Verbesserung hinsichtlich Beschwerden, Medikamentenverbrauch und pH-Metriedaten gezeigt werden. Technische Weiterentwicklungen wie die Verwendung von 2 Nähten werden zur Zeit in Studien evaluiert.

Abstract

Heartburn, the most common symptom associated with GERD, occurs in 10-20 % of the US and western European population. Life long PPI therapy for GERD is often required since symptoms typically recur once therapy has been discontinued. Recently a couple of endoscopic antireflux procedures have been developed. These techniques include injection or implantation of biopolymers and application of radiofrequency. Most of the techniques have been abandoned due to lack of long-term efficacy or serious side effects. Since first generation endoluminal suturing techniques showed insufficient durability, due to suture loss, the transmural plication technique Plicator™ was developed. In a prospective-randomized, sham-controlled trial the Plicator proved superiority concerning reflux symptoms, medication use and esophageal acid exposure. Further technical improvements like the use of 2 sutures are currently investigated.

endoskopische Antirefluxtherapie - GERD - Plicator™ - endoskopische Fundoplicatio

endoscopic antireflux therapy - GERD - Plicator™ - endoscopic Fundoplicatio

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