Treatment of Gastroesophageal Reflux Disease: Endoscopic Aspects

Špičák, Julius

doi:10.1159/000103882

Cited by 5 publications

(2 citation statements)

References 36 publications

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“…The goals of clinical management of gastroesophageal disease (GERD) are prompt symptom relief, long-term symptom control, and maintenance of esophageal healing [2, 3]. The current algorithm for the effective treatment of GERD consists of antisecretory medication at all patient care levels [4].…”

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confidence: 99%

Transoral incisionless fundoplication for treatment of gastroesophageal reflux disease in clinical practice

et al. 2012

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BackgroundTransoral incisionless fundoplication is a recently introduced endoluminal technique for the treatment of gastroesophageal reflux disease (GERD). The objective of this study was to determine outcomes in chronic GERD patients who were referred for surgical management.MethodsA cohort of 38 patients underwent transoral incisionless fundoplication (TIF) in a tertiary care setting. Pre- and post-procedure assessment included GERD-related quality of life questionnaires, proton pump inhibitor (PPI) usage, 24-h pH measurements, upper gastrointestinal endoscopy, esophageal manometry, and registration of adverse events. Duration of follow-up was 36 months.ResultsGastroesophageal valves were constructed of 4 cm (range, 4–6) in length and 220° (range, 180–240) in circumference. One serious adverse event occurred, consisting of intraluminal bleeding at a fastener site. Hiatal hernia was completely reduced in 56 % and esophagitis was cured in 47 % of patients. Postprocedure esophageal acid exposure did not significantly improve (p > 0.05). At 36 (range, 29–41) months follow-up 14 patients (36 %) had undergone revisional laparoscopic fundoplication. Quality of life scores of the remaining cohort showed significant improvement (p < 0.0001) and daily use of antisecretory medication was discontinued by 74 %.ConclusionsEndoluminal fundoplication improved quality of life and reduced the need for PPIs in only a subgroup of patients at 3 years follow-up. The amount of patients requiring additional medication and revisional surgery was high.

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confidence: 99%

Transoral incisionless fundoplication for treatment of gastroesophageal reflux disease in clinical practice

et al. 2012

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“…Radiofrequency heating (RFH) is employed in many surgical and therapeutic procedures such as the elimination of cardiac arrhythmias (Berjano and Hornero 2005), the destruction of tumors (Leen and Horgan 2007), the treatment of gastroesophageal reflux disease (Spicák 2007) and the heating of the cornea for refractive surgery (Berjano et al 2007). In order to understand the complex electrical and thermal phenomena involved in the RFH process, numerous theoretical models have been employed (Berjano 2006).…”

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Effect of the thermal wave in radiofrequency ablation modeling: an analytical study

Molina¹,

Rivera²,

Trujillo³

et al. 2008

Phys. Med. Biol.

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To date, all radiofrequency heating (RFH) theoretical models have employed Fourier's heat transfer equation (FHTE), which assumes infinite thermal energy propagation speed. Although this equation is probably suitable for modeling most RFH techniques, it may not be so for surgical procedures in which very short heating times are employed. In such cases, a non-Fourier model should be considered by using the hyperbolic heat transfer equation (HHTE). Our aim was to compare the temperature profiles obtained from the FHTE and HHTE for RFH modeling. We built a one-dimensional theoretical model based on a spherical electrode totally embedded and in close contact with biological tissue of infinite dimensions. We solved the electrical-thermal coupled problem analytically by including the power source in both equations. A comparison of the analytical solutions from the HHTE and FHTE showed that (1) for short times and locations close to the electrode surface, the HHTE produced temperatures higher than the FHTE, however, this trend became negligible for longer times, when both equations produced similar temperature profiles (HHTE always being higher than FHTE); (2) for points distant from the electrode surface and for very short times, the HHTE temperature was lower than the FHTE, however, after a delay time, this tendency inverted and the HHTE temperature increased to the maximum; (3) from a mathematical point of view, the HHTE solution showed cuspidal-type singularities, which were materialized as a temperature peak traveling through the medium at a finite speed. This peak rose at the electrode surface, and clearly reflected the wave nature of the thermal problem; (4) the differences between the FHTE and HHTE temperature profiles were smaller for the lower values of thermal relaxation time and locations further from the electrode surface.

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Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX

et al. 2009

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Background A feasibility study (n = 19) evaluated the safety and initial efficacy of transoral incisionless fundoplication (TIF) for the treatment of gastroesophageal disease (GERD). The results at 1 year (n = 17) indicated that TIF was safe and had a significant effect on reducing GERD symptoms, proton pump inhibitor (PPI) usage, acid exposure, and small hiatal hernia. This study was designed to evaluate the long-term safety and durability of TIF. Methods Fourteen patients (50% female; median age, 34 years) completed the 2-year follow-up assessment tests. Three patients were excluded from the study after 1 year because two of them underwent retreatment and one was lost to follow-up. Results At 2 years, no adverse events related to TIF were reported. A C50% improvement in GERD-HRQL scores compared with those at baseline on PPIs was sustained by 64% of patients. TIF was effective in eliminating heartburn in 93% of patients and daily PPI therapy in 71% of patients. Significantly (p \ 0.05) more patients were able to consume reflux-causing foods and maintain lifestyle activities without GERD symptoms compared with baseline on PPIs. Fundoplications were durable and maintained their geometric dimensions. TIF was effective in eliminating hiatal hernia in 60% of patients and esophagitis in 55% of patients. Global assessment of all outcomes in each patient revealed that 79% of patients experienced complete cure (29%) or remission (50%) of GERD at 2 years after TIF. Conclusion The results at 2 years supported the longterm safety and durability of TIF and its sustained effect on the elimination of heartburn, esophagitis, B2 cm hiatal hernia, and daily dependence on PPIs.

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Treatment of Gastroesophageal Reflux Disease: Endoscopic Aspects

Cited by 5 publications

References 36 publications

Transoral incisionless fundoplication for treatment of gastroesophageal reflux disease in clinical practice

Transoral incisionless fundoplication for treatment of gastroesophageal reflux disease in clinical practice

Effect of the thermal wave in radiofrequency ablation modeling: an analytical study

Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX

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