Endoscopic treatment of cardia lesions: the effects on gastroesophageal reflux disease

Abstract

Background: Drug treatment is the main form of management for patient with gastroesophageal reflux disease (GERD). However, long-term medication can increase the psychological burden of patients. Furthermore, in some patients, standardized drug treatments do not effectively control their condition.Traditional anti-reflux surgery has a low degree of acceptance due to its trauma and many associated complications. In contrast, endoscopic minimally invasive surgery is preferable. This study explored the effects of endoscopic treatment of cardia diseases on GERD.Methods: A retrospective analysis was conducted on 106 patients with cardia disease (including cardia polyp, precancerous lesion, and early cardia cancer) and reflux esophagitis (RE). Patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), and the rates of complete resection, postoperative complications, and postoperative reflux were assessed.Results: Among the 106 lesions, 104 lesions were completely resected, and 2 early cancers were cured. No delayed hemorrhage was detected in any of the cases. The GERD-HRQL (gastroesophageal reflux diseasehealth related quality of life) and GERD-Q (gastroesophageal reflux disease-questionnaires) scores decreased significantly at 3 and 6 months post-operation (P<0.001). Furthermore, the RE grade was significantly different before and after the operation (P<0.001). The basic cure rate at 3 and 6 months after the operation was 83.96% and 84.91%, respectively, and the significant remission rate was 10.38% and 8.49%, respectively.Conclusions: Endoscopic treatment of cardia conditions is advantageous due to low levels of trauma, higher complete resection rates, and fewer complications. Moreover, the fibrous scar generated after endoscopic treatment forms an anti-reflux barrier, which can alleviate or even cure RE to a certain extent.This may represent a promising method for the clinical treatment of GERD.

Health-related quality of life after super minimally invasive surgery and proximal gastrectomy for early-stage adenocarcinoma of the esophagogastric junction: a propensity score-matched study

“…In addition, the proportion of patients with post-operative acid reflux in the SMIS group in our study was lower than that previously reported in the normal healthy group [2] . This may be because scar contraction after SMIS increases the pressure of the lower esophageal sphincter, reconstructing the shape of the esophageal valve flap, producing an effect similar to peroral endoscopic cardial constriction, and relieving reflux to a certain extent [3] . The symptoms of swallowing problems and pain after PG are more obvious than those of SMIS, which may be explained by the stenosis of the anastomotic stoma, causing difficulty in feeding.…”

“…[ 2 ] This may be because scar contraction after SMIS increases the pressure of the lower esophageal sphincter, reconstructing the shape of the esophageal valve flap, producing an effect similar to peroral endoscopic cardial constriction, and relieving reflux to a certain extent. [ 3 ] The symptoms of swallowing problems and pain after PG are more obvious than those of SMIS, which may be explained by the stenosis of the anastomotic stoma, causing difficulty in feeding. Additionally, the lack of a gastrointestinal pacemaker and severing of the vagus nerve after gastrectomy leads to weakened gastric motility, thus affecting gastric emptying disorders.…”