Clinical Study On The Treatment Of Gastroesophageal Reflux By Peroral Endoscopic Cardial Constriction

Objective:To explore the clinical efficacy and safety of Peroral Endoscopic Cardial constriction(PECC)in the treatment of Gastro-Esophageal Reflux Disease(GERD),and to provide reliable materials for its research work.It also provides more possibilities for clinical endoscopic treatment of GERD.Methods: From August 2017 to January 2020,patients with GERD and completed PECC in the Department of Gastroenterology,Affiliated Hospital of Inner Mongolia Medical University were collected for prospective study.Collect the general clinical data of the patients,and compare the relevant data before operation,6 months after operation and 12 months after operation,including Gastro-Esophageal Reflux Disease – Questionnaires(GERD-Q)scores,gastroesophageal reflux disease – health related quality of life(GERD-HRQL)scores,patients’ satisfaction with symptom improvement,gastroscopy(Los Angeles classification),24-hour esophageal p H monitoring(De Meester score)and high-resolution esophageal manometry(HREM)upper gastrointestinal barium X-ray radiography(UGI-XR)and detection of intraoperative and postoperative complications.In order to evaluate the efficacy and safety of PECC in the treatment of GERD.Results: From August 2017 to January 2020,a total of 47 patients who met the inclusion and exclusion criteria received PECC treatment.According to the results of the postoperative follow-up content,the results showed:1.The symptoms of GERD patients were significantly improved after the operation,and the GERD-Q score and GERD-HRQL score were significantly lower than those before the operation: the GERD-Q score was reduced from preoperative(13.55.±2.35)points to 6(6,6)points after surgery.December 6(6-6)points after surgery;The GERD-HRQL score decreased from(21.59±4.92)points before surgery to 2(2,3)points at 6 months after surgery and 2(2,3)points at 12 months after surgery.The difference was statistically significant(P<0.01),while comparing the GERD-Q score and GERD-HRQL score at 6 and 12 months after surgery,the difference was not statistically significant(P = 0.53).2.The follow-up of gastroscopy showed that the inflammation of the esophagus was significantly improved compared with that before the operation,and the degree of cardia relaxation was better than before.The esophageal mucosa returned to normal in37 cases(78.72%)after June and 31 cases(65.95%)after December;Comparing the24-hour esophageal PH monitoring results of patients before PECC and 6 months and12 months after operation showed that the esophageal De Meester score,p H<4percentage time,number of refluxes,number of long refluxes and duration were significantly lower than those before surgery,and the difference was significant.All have statistical significance;Comparing the HREM of patients before PECC operation and 6 months and 12 months after operation showed that the resting pressure and residual pressure of lower esophageal sphincter(LES)were higher than those before operation,and the difference was statistically significant;Postoperative UGI-XR showed that the degree of cardiac slack was tighter than before,the His°became slightly sharper,and the anti-reflux barrier was strengthened.3.The effective rates of 6 months and 12 years after PECC were 97.9% and 93.7%respectively,among which 85.1% and72.4% cases were clinically cured.The effective rate of 6 months after PECC was slightly higher than that of 12 months after PECC,but the difference was not statistically significant.Patients’ satisfaction with the surgical effect was also high,33(70.22%)were satisfied with the surgical effect,11patients(23.40%)were satisfied with the average degree,and 3 patients(6.38%)were not satisfied with the operation;PECC was no serious complications during and after the operation.17 cases(36.17%)had poststernal pain and 9 cases(19.14%)had poststernal constriction,but they were relieved within 2 days.Conclusion: PECC can control symptoms,increase LES pressure in patients and reduce acid exposure with gastroesophageal reflux disease.It has high efficacy,low risk and fewer complications,and is a safe and effective new endoscopic treatment method.