Outcomes of endoscopic submucosal dissection for gastroesophageal reflux disease (ESD-G) for medication-refractory gastroesophageal reflux disease: 35 cases underwent ESD-G including 15 cases followed more than 5 years

Abstract

Background Although some kinds of endoluminal surgery for patients with proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) have been reported, there are few reports on their long-term outcomes. In 2014, we reported the effectiveness of endoscopic surgery for PPI-refractory GERD, which we invented and named endoscopic submucosal dissection for GERD (ESD-G) in 2008. Thereafter, we accumulated more cases and monitored the patients’ condition postoperatively and describe the outcomes herein. Patients and methods This single-center, single-arm trial was conducted at the Osaka Medical and Pharmaceutical University Hospital. We compared outcomes between before and 3–6 months after ESD-G. Additionally, we investigated the outcomes of patients 5 or more years after ESD-G. Results We performed 42 ESD-G procedures in 35 patients between 2008 and 2020. In seven patients, ESD-G was performed twice for various reasons. The frequency scale for the symptoms of GERD score was significantly improved 3–6 months after ESD-G (22 → 10, p < 0.0001); the Los Angeles classification for reflux esophagitis was clearly improved after ESD-G (p = 0.0423). The number of reflux episodes was not decreased by ESD-G. There was a significant difference in the potency unit of gastric acid secretion suppressants for controlling GERD-related symptoms between baseline and 3–6 months after ESD-G (p = 0.0009). In patients without a history of distal gastrectomy who underwent ESD-G, the potency unit of gastric acid secretion suppressants significantly decreased 5 or more years after ESD-G (p = 0.0121). Conclusion ESD-G may be effective in patients with refractory GERD-related symptoms without a history of distal gastrectomy.

In Vitro and In Vivo Investigation on the Effectiveness of Alginate-Based Gastric Mucosal Protective Gel

“…However, there is no good measures to protect the wound after the surgery at present, and the wound after mucosal dissection is only treated with hemostasis, which is not conducive to wound healing. Under the action of gastric acid and pepsin, the wound healing time is longer, and the wound is easier to form scar tissue [ 16 , 17 ]. Clinical research [ 45 ] showed that the healing rate of patients undergoing endoscopic gastric mucosal resection and gastric mucosal dissection at 6 weeks was about 69%.…”

“…ESD can resect a larger lesion compared with endoscopic mucosal resection (EMR) [14][15][16][17]. With the advantages of less trauma and lower recurrence rate, it has gradually replaced some traditional surgical procedures [17][18][19].…”

“…With the advantages of less trauma and lower recurrence rate, it has gradually replaced some traditional surgical procedures [17][18][19]. However, ESD usually results in a larger ulcer wound than EMR, and a high frequency of complications such as severe perforation and bleeding has been found for ESD [16,17]. It has been reported that an ESD-induced ulcer needs 8 weeks to heal because of exposing longer to gastric acid and pepsin [12,17,20,21].…”

Frontiers in Endoscopic Treatment for Gastroesophageal Reflux Disease

“…For ESD-G, half of the mucosa in the gastroesophageal junction zone is resected endoscopically from the esophageal side [6]. We have previously reported that ESD-G is effective in patients with refractory GERD-related symptoms without a history of distal gastrectomy [9]. A significant reduction in the dose of each acid secretion inhibitor was observed after ESD-G.…”

“…ESD-G. Reprinted from Reference [9]. Endoscopic findings at the esophagogastric junction in a patient who underwent endoscopic submucosal dissection for gastroesophageal reflux disease (ESD-G).…”