Application Of Endoscopic Cardia Mucosal Resection In The Treatment Of Refractory Gastroesophageal Reflux Disease

Objective:To study the efficacy and safety of endoscopic resection of cardiac mucosa in the clinical treatment of refractory gastroesophageal reflux disease.Methods:In this study,a retrospective study was conducted to collect patients with refractory gastroesophageal reflux(with or without cardiac mucosal lesions,including cardiac polyps,early cancer,submucosal tumor etc.)who were admitted to The Second Affiliated Hospital of Nanchang University during the two-year period from September 2020 to September 2022 and who had the intention of receiving endoscopic treatment.A total of 30 patients who met the inclusion and exclusion criteria of this study and voluntarily received endoscopic cardia mucosa resection(Including EMR,ESD,ARMS and other operations)were selected.The included patients were investigated by GERD-Q and GERD-HRQL before surgery and at the first,third and sixth months after surgery.The patients were followed up on their satisfaction with the relief and improvement of symptoms after cardiac mucosa resection.The survey results were recorded in detail,and the use of PPI and other drugs were recorded during follow-up visits.The enrolled patients underwent electronic gastroscopy before surgery and at the sixth month after surgery.The relevant examination results and data recorded before and after surgery were compared and analyzed,so as to make a reasonable analysis and judgment of the effect and safety of endoscopic cardia mucosa resection in the clinical treatment of refractory gastroesophageal reflux disease.Results:All the 30 enrolled patients underwent successful surgery,and the average operation time was(45.30±1.698)minutes.No serious intraoperative or postoperative complications occurred.The overall recovery of the patients was good,and there were no serious clinical events that were difficult to treat and remedy or patients reached the end of life.After treatment,the dose of PPI was gradually reduced.At 6months after surgery,16 patients(53.3%)had stopped or basically stopped using PPIs drugs,and 14 patients(46.7%)only needed intermittent use of PPIs.The reflux symptom scores of patients 1,3 and 6 months after surgery were(11.10±1.029),(9.57±0.728)and(8.60±0.498)points,respectively,which were lower than those before surgery(13.23±0.858)points,and the difference was statistically significant(P<0.05).Health-related quality of life evaluation scores(GERD-HRQL)(20.27±4.601),(15.50± 2.921),(12.20±2.140)of 30 patients 1,3 and 6 months after surgery were lower than those before surgery(25.33±5.047).The difference was statistically significant(P<0.05).The results of electronic gastroscopy 6 months after surgery indicated that,in general direction,the Los Angeles grade of esophagitis(LA grade)changed from preoperative B-C grade to postoperative A-B grade,and the GEFV grade changed from preoperative III or even IV grade to postoperative II grade and even returned to normal.Among the 30 patients,25 had no complications,3 had intraoperative perforation(the wound was successfully closed with titanium clamps),and 1 patient had delayed postoperative bleeding events.One patient had mild infection after the operation,the symptoms were not serious,but were obviously relieved after anti-infection treatment,and no serious adverse effects on postoperative recovery were caused.Ten patients(33.3%)were very satisfied,6(20%)were relatively satisfied,8(26.7%)were basically satisfied,and 6(20%)were not satisfied.Conclusions:When applied in the clinical treatment of refractory gastroesophageal reflux disease,the endoscopic cardia mucosal resection has positive clinical effect in the short term,can significantly relieve the discomfort symptoms of patients,and fewer serious complications occur,with high safety and good clinical application value,and can be used as a drug treatment effect is not significant or even poorly controlled.A premium intermediate option when surgical treatment is not desirable.The satisfaction degree of postoperative symptom improvement was positively correlated with the scope of mucosal resection.However,the treatment of possible complications caused by surgery such as bleeding,perforation,abnormal postoperative esophageal stenosis and the determination of the scope of mucosal resection,the therapeutic effect in patients with r GERD without cardiac mucosal lesions,as well as the relevant research on its long-term efficacy,In the future,it is necessary to carry out reliable clinical studies with large samples,multi-center,randomized control and long-term follow-up for further discussion.