Preliminary Discussion Of Endoscopic Cardial Mucosal Ligation Remodeling In The Treatment Of Refractory Gastroesophageal Reflux Disease

Objective:Analyze the characteristics,short-term efficacy,intraoperative and postoperative complications of endoscopic cardial mucosal ligation remodeling.And explore its safety,efficacy and feasibility as a novel surgical method of refractory gastroesophageal reflux disease.Methods:Fifteen patients with refractory gastroesophageal reflux disease who underwent endoscopic cardial mucosal ligation remodeling from August 2018 to December 2020 in the First Affiliated Hospital of Xiamen University were selected,and relevant data were collected and retrospectively analyzed.Surgical method:①Enter the endoscope to investigate the esophagus,cardiac mucosa and degree of relaxation,and the condition of the gastric fundus;②Retreat the endoscope and install the Ligation device.After entering the endoscope,select 4 points around the cardia opening in the gastric fundus flip position and release the ligature ring for ligature after full negative pressure suction on the mucosa in order to form a spherical mucosal protrusion of about 1.0cm in diameter.Observe whether there is bleeding or perforation;③Retreat the endoscope to the esophageal side of the cardia.Perform the same ligature operation at one point on the anterior and posterior wall of the esophagus.After the front-end ligation device was removed,a gastroscope was inserted into the esophagus and gastric fundus to observe the state of the cardia after ligation on both sides.The relevant data of the patients,related examination records before and after the operation,GERD-Q scores before and three months after the operation were collected to compare the differences of the main clinical observation indexes before and after the operation.Results:13/15 patients had better postoperative symptoms,and operative complications were few and slight.The GERD-Q score decreased from(13.53±3.48)points preoperatively to(9.87±3.36)points three months later.P<0.05,the difference was statistically significant.Conclusion:①Endoscopic cardial mucosal ligation remodeling,as a new surgical procedure with good curative effect,easy operation,less trauma,and quick recovery,can be used in the treatment of refractory gastroesophageal reflux disease;②Endoscopic cardial mucosal ligation remodeling has a low complication rate.It is safe and reliable for the treatment of refractory gastroesophageal reflux disease;③Endoscopic cardial mucosal ligation remodeling has a short operative time and average hospital stay.It can provide an effective treatment for a large number of patients with refractory gastroesophageal reflux disease;④Preliminary studies showed good short-term efficacy.Due to the short duration and fewer cases,further large-sample clinical controlled studies and longer follow-up are needed in the future to assess its long-term efficacy.