胃食道逆流性疾患に対する内膜内治療法
Jean Paul Galmiche1, Stanislas Bruley des Varannes
1Department of Gastroenterology and Hepatology, CIC INSERM, CHU Nantes, 44093, Nantes, France. galmiche@easynet.fr <galmiche@easynet.fr>
Lancet (London, England)
|April 4, 2003
まとめ
放射能エネルギーや縫合などの内視鏡治療は,胃食道逆流性疾患 (GORD) の管理に有望であり,初期試験では最小限の合併症で陽子ポンプ阻害剤 (PPI) の依存度を軽減します.
科学分野:
- 胃腸内科 胃腸内科
- 最低侵襲的処置とは
背景:
- 胃食道逆流症 (Gastro-oesophageal reflux disease,GORD) は慢性疾患であり,生活の質に重大な影響を及ぼし,しばしばプロトンポンプ阻害剤 (PPI) で管理されます.
- PPIのような現在の治療法は効果的ですが,コストが高く,根本的な反流症障害に対処していませんが,外科手術は著しい罹病率と費用対効果の課題を提示しています.
- エンドスコピーの技術は,慢性GORDに対する潜在的な外来治療の解決策を提供します.
研究 の 目的:
- 慢性GORDの2つの異なる内視鏡介入の1年間の結果を評価するために:放射能エネルギー配信 (Stretta手順) と内視鏡縫合.
- これらの内視鏡治療がGORDの症状,生活の質,薬剤の必要性,および安全性プロファイルに与える影響を評価する.
主な方法:
- 2つの前向きなオープンラベル研究が検討され,一つは94人の患者の胃食道節への放射能の送電,もう一つは26人の患者の内視縫合に関する研究でした.
- 両試験の患者には慢性的なGORD症状があり,PPI療法を受け,重度の食道炎や大きな間隙ヘルニアはなかった.
- 12ヶ月のフォローアップでは,症状の改善,生活の質,食道酸の曝露,PPI治療の必要性を評価しました.
主要な成果:
- ラジオ周波数エネルギー伝達と内視縫合の両方が,1年後にGORDの症状と生活の質の有意な改善を示しました.
- PPI治療の必要性は,放射能治療後の98%から30%に,内視縫合後の100%から36%に大幅に減少しました.
- 両方の処置は軽微な合併症のみを伴い,特定の介入を必要としなかった.
結論:
- 放射性周波数エネルギー伝達と内視縫合を含む内視鏡治療は,慢性GORDを外来的に管理するための有望な進歩を表しています.
- 効果を確認し,長期的な安全性を評価し,医療管理と比較して費用対効果を評価するために,より長いフォローアップを伴うさらなるよく制御された研究が必要である.
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