Endoscopic Stenosis And Deep Ligation Technique For The Treatment Of Severe Gastroesophageal Reflux Disease With Esophageal Hiatal Hernia: Report Of 2 Cases

Objective:To investigate the operation points,safety analysis and related complications of endoscopic deep ligature in the treatment of severe gastroesophageal reflux disease with esophageal hiatal hernia.Methods:Two patients with severe gastroesophageal reflux disease and esophageal hiatal hernia diagnosed in the Department of Gastroenterology,Second Hospital of Hebei Medical University in 2018,underwent deep anesthesia with general anesthesia,and the two cases were postoperatively（Gastroesophageal refulxd）Disease questionnaire GerdQ)score,gastroscopy,high reolusion manometry（HRM）,24-hour PH monitoring follow-up and analysis to evaluate its efficacy.The GerdQ score is divided into 8intermediate values.The lower the score,the more obvious the improvement of symptoms^[1].The PPIs should be stopped for 2 weeks before the 24-hour PH monitoring.Results:Two patients underwent deep anesthesia with general anesthesia,and no serious treatment-related complications and deaths occurred.The symptoms were all relieved after treatment,and the GerdQ score was significantly lower than before.Gradually reduced,one of the patients gradually discontinued the drug.The postoperative re-examination of the gastroscope showed that the hernia sac was significantly smaller than before,the relaxation of the sacral opening was improved,and the inflammation of the esophageal mucosa was less than before,but the results of the high-resolution esophageal manometry were not the same.The lower esophageal sphincter relaxation rate gradually increased,without esophageal hiatal hernia.However,in the first patient,the lower esophageal sphincter resting pressure treatment increased from a tendency to a downward trend,and the esophageal body peristalsis contracted from high amplitude to normal peristalsis after treatment;In the second patient,the lower esophageal sphincter resting pressure was in a downward trend,and the esophageal body peristalsis was worse than before treatment.Conclusion:Endoscopic stenosis and deep ligation technique for the treatment of severe gastroesophageal reflux disease with esophageal hiatus hernia has a positive effect,no obvious treatment-related complications,can improve the quality of life of patients,reduce the use of PPIs,improve esophageal mucosal inflammation,and make esophageal hiatus The reduction of sputum and overall improvement of esophageal electrophysiology,however,research to be examined for long-term effects and complications.