Skip to main content
Erschienen in:

23.04.2021 | Original Article

Therapeutic effect of laparoscopic fundoplication for patients with GERD from the viewpoint of Lyon Consensus

verfasst von: Masato Hoshino, Nobuo Omura, Fumiaki Yano, Kazuto Tsuboi, Se Ryung Yamamoto, Shunsuke Akimoto, Takahiro Masuda, Yuki Sakashita, Naoko Fukushima, Hideyuki Kashiwagi

Erschienen in: Esophagus | Ausgabe 4/2021

Einloggen, um Zugang zu erhalten

Abstract

Background and objectives

The Lyon Consensus was conducted in 2017, leading to a revision of the diagnostic criteria of GERD. Conclusive GERD was defined as cases in which the distal esophageal acid exposure time (AET) is greater than 6% and there exists either peptic esophagitis, constriction, or long-segment Barrett’s mucosa with a Los Angeles classification of grade C or D. Borderline GERD is defined as cases in which AET is between 4 and 6% and there exists peptic esophagitis with a Los Angeles classification of either grade A or B. All other cases were defined as Inconclusive GERD. We conducted a retrospective investigation of the treatment results of laparoscopic fundoplication (LF) for GERD according to the Lyon Consensus and evaluated whether or not it is an effective treatment predictor.

Materials and methods

From among the cases of primary LF conducted on patients with GERD-related illnesses at our university hospital from June 2008 to March 2020, the subjects included 215 individuals who underwent upper gastrointestinal endoscopy and 24 h multichannel intraluminal impedance pH (MII-pH) testing prior to surgery. We compared the pathophysiology of the Conclusive GERD Group (Group A), Borderline GERD Group (Group B), and Inconclusive GERD Group (Group C), and then investigated the treatment results of each group. We used AFP classification for pathophysiological evaluation. For the acid reflux evaluation, we conducted MII-pH measurements using Sleuth, manufactured by Sandhill. The postoperative evaluation period was set to 3 months following surgery. The data are expressed using median values, with a statistical significance defined as p < 0.05 using the Kruskal–Wallis, Mann–Whitney, Wilcoxon signed-rank, and Chi-squared tests.

Results

Group A: 92 cases (43%, male 69 cases, age 57), Group B: 48 cases (22%, male 20 cases, age 52), and Group C: 75 cases (35%, male 69 cases, age 57). Regarding the patient backgrounds, while there were no significant differences in terms of gender or disease duration, those in Group A were significantly older than the other two groups, and there was a significant difference in Body Mass Index (BMI) between Group A and Group C. The results of each factor were: A factor (1 vs.1 vs. 1, p < 0.001), F factor (2 vs. 0 vs. 0, p < 0.001), and P factor (2 vs. 1 vs. 0, p < 0.001), with AET of 10.0 vs. 2.9 vs. 0.6, p < 0.001, and the disease had progressed more in Group A. There were also no differences in terms of surgical methods, hemorrhage volume, and intraoperative/postoperative complications; however, the use of mesh was higher and surgery duration was longer in Group A. There were obvious improvements in the A, F, and P factors and AET of each group following surgery (other than F and P of Group C, p < 0.001). The rate of recurrence was 15% in Group A, 8% in Group B, and 6% in Group C. It tended to be higher in Group A, but this was not statistically significant.

Conclusion

The classification of GERD pathophysiology based on the Lyon Consensus is satisfactory, with no significant differences in the rate of effect of LF. The Lyon Consensus is effective for ascertaining the severity and pathophysiology of GERD; however, we were unable to forecast the treatment results of LF.
Literatur
1.
Zurück zum Zitat Roman S, Gyawali CP, Savarino E, GERD consensus group, et al. Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: update of the porto consensus and recommendations from an international consensus group. Neurogastroenterol Motil. 2017;29(10):1–15.CrossRef Roman S, Gyawali CP, Savarino E, GERD consensus group, et al. Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: update of the porto consensus and recommendations from an international consensus group. Neurogastroenterol Motil. 2017;29(10):1–15.CrossRef
2.
Zurück zum Zitat Gyawali CP, Roman S, Bredenoord AJ, et al. Classification of esophageal motor findings in gastro-esophageal reflux disease: conclusions from an international consensus group. Neurogastroenterol Motil. 2017;29(12):e13104.CrossRef Gyawali CP, Roman S, Bredenoord AJ, et al. Classification of esophageal motor findings in gastro-esophageal reflux disease: conclusions from an international consensus group. Neurogastroenterol Motil. 2017;29(12):e13104.CrossRef
3.
Zurück zum Zitat Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018;67(7):1351–62.CrossRef Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018;67(7):1351–62.CrossRef
5.
Zurück zum Zitat Ghisa M, Barberio B, Savarino V, et al. The Lyon Consensus: does it differ from the previous ones? J Neurogastroenterol Motil. 2020;26(3):311–21.CrossRef Ghisa M, Barberio B, Savarino V, et al. The Lyon Consensus: does it differ from the previous ones? J Neurogastroenterol Motil. 2020;26(3):311–21.CrossRef
6.
Zurück zum Zitat Zhang M, Tan N, Li Y, Chen M, Xiao Y. Esophageal physiologic profiles within erosive esophagitis in China: predominantly low-grade esophagitis with low reflux burden. Neurogastroenterol Motil. 2019;31(12):e13702.CrossRef Zhang M, Tan N, Li Y, Chen M, Xiao Y. Esophageal physiologic profiles within erosive esophagitis in China: predominantly low-grade esophagitis with low reflux burden. Neurogastroenterol Motil. 2019;31(12):e13702.CrossRef
7.
Zurück zum Zitat Omura N, Kashiwagi H, Yano F, et al. Prediction of recurrence after laparoscopic fundoplication for erosive reflux esophagitis based on anatomy-function-pathology (AFP) classification. Surg Endosc. 2007;21(3):427–30.CrossRef Omura N, Kashiwagi H, Yano F, et al. Prediction of recurrence after laparoscopic fundoplication for erosive reflux esophagitis based on anatomy-function-pathology (AFP) classification. Surg Endosc. 2007;21(3):427–30.CrossRef
8.
Zurück zum Zitat Omura N, Yano F, Tsuboi K, et al. Surgical results of laparoscopic Toupet fundoplication for gastroesophageal reflux disease with special reference to recurrence. Esophagus. 2018;15(4):217–23.CrossRef Omura N, Yano F, Tsuboi K, et al. Surgical results of laparoscopic Toupet fundoplication for gastroesophageal reflux disease with special reference to recurrence. Esophagus. 2018;15(4):217–23.CrossRef
9.
Zurück zum Zitat Koch OO, Asche KU, Berger J, Weber E, Granderath FA, Pointner R. Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty. Surg Endosc. 2011;25(4):1024–30.CrossRef Koch OO, Asche KU, Berger J, Weber E, Granderath FA, Pointner R. Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty. Surg Endosc. 2011;25(4):1024–30.CrossRef
10.
Zurück zum Zitat Tutuian R, Vela MF, Shay SS, Castell DO. Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring. J Clin Gastroenterol. 2003;37(3):206–15.CrossRef Tutuian R, Vela MF, Shay SS, Castell DO. Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring. J Clin Gastroenterol. 2003;37(3):206–15.CrossRef
11.
Zurück zum Zitat Feussner H, Petri A, Walker S, Bollschweiler E, Siewert JR. The modified AFP score: an attempt to make the results of anti-reflux surgery comparable. Br J Surg. 1991;78(8):942–6.CrossRef Feussner H, Petri A, Walker S, Bollschweiler E, Siewert JR. The modified AFP score: an attempt to make the results of anti-reflux surgery comparable. Br J Surg. 1991;78(8):942–6.CrossRef
12.
Zurück zum Zitat Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45(2):172–80.CrossRef Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45(2):172–80.CrossRef
13.
Zurück zum Zitat Hoshino M, Omura N, Yano F, et al. Comparison of laparoscopic Nissen and Toupet fundoplication using a propensity score matching analysis. Surg Today. 2017;47(10):1195–200.CrossRef Hoshino M, Omura N, Yano F, et al. Comparison of laparoscopic Nissen and Toupet fundoplication using a propensity score matching analysis. Surg Today. 2017;47(10):1195–200.CrossRef
14.
Zurück zum Zitat Johnson LF, Demeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974;62(4):325–32.PubMed Johnson LF, Demeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974;62(4):325–32.PubMed
15.
Zurück zum Zitat Burgerhart JS, van de Meeberg PC, Siersema PD, Smout AJ. Nocturnal and daytime esophageal acid exposure in normal-weight, overweight, and obese patients with reflux symptoms. Eur J Gastroenterol Hepatol. 2014;26(1):6–10.CrossRef Burgerhart JS, van de Meeberg PC, Siersema PD, Smout AJ. Nocturnal and daytime esophageal acid exposure in normal-weight, overweight, and obese patients with reflux symptoms. Eur J Gastroenterol Hepatol. 2014;26(1):6–10.CrossRef
16.
Zurück zum Zitat Hiyama T, Matsuo K, Urabe Y, et al. Meta-analysis used to identify factors associated with the effectiveness of proton pump inhibitors against non-erosive reflux disease. J Gastroenterol Hepatol. 2009;24(8):1326–32.CrossRef Hiyama T, Matsuo K, Urabe Y, et al. Meta-analysis used to identify factors associated with the effectiveness of proton pump inhibitors against non-erosive reflux disease. J Gastroenterol Hepatol. 2009;24(8):1326–32.CrossRef
17.
Zurück zum Zitat Armijo PR, Pokala B, Misfeldt M, Pagkratis S, Oleynikov D. Predictors of hiatal hernia recurrence after laparoscopic anti-reflux surgery with hiatal hernia repair: a prospective database analysis. J Gastrointest Surg. 2019;23(4):696–701.CrossRef Armijo PR, Pokala B, Misfeldt M, Pagkratis S, Oleynikov D. Predictors of hiatal hernia recurrence after laparoscopic anti-reflux surgery with hiatal hernia repair: a prospective database analysis. J Gastrointest Surg. 2019;23(4):696–701.CrossRef
18.
Zurück zum Zitat Broeders JA, Draaisma WA, Bredenoord AJ, Smout AJ, Broeders IA, Gooszen HG. Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease. Br J Surg. 2010;97(6):845–52.CrossRef Broeders JA, Draaisma WA, Bredenoord AJ, Smout AJ, Broeders IA, Gooszen HG. Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease. Br J Surg. 2010;97(6):845–52.CrossRef
19.
Zurück zum Zitat Omura N, Kashiwagi H, Yano F, et al. Therapeutic effects of laparoscopic fundoplication for nonerosive gastroesophageal reflux disease. Surg Today. 2006;36(11):954–60.CrossRef Omura N, Kashiwagi H, Yano F, et al. Therapeutic effects of laparoscopic fundoplication for nonerosive gastroesophageal reflux disease. Surg Today. 2006;36(11):954–60.CrossRef
Metadaten
Titel
Therapeutic effect of laparoscopic fundoplication for patients with GERD from the viewpoint of Lyon Consensus
verfasst von
Masato Hoshino
Nobuo Omura
Fumiaki Yano
Kazuto Tsuboi
Se Ryung Yamamoto
Shunsuke Akimoto
Takahiro Masuda
Yuki Sakashita
Naoko Fukushima
Hideyuki Kashiwagi
Publikationsdatum
23.04.2021
Verlag
Springer Singapore
Erschienen in
Esophagus / Ausgabe 4/2021
Print ISSN: 1612-9059
Elektronische ISSN: 1612-9067
DOI
https://doi.org/10.1007/s10388-021-00843-z

Kompaktes Leitlinien-Wissen Innere Medizin (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Neu im Fachgebiet Innere Medizin

Metastasiertes CRC: besser Checkpointhemmer im Doppelpack!

Die Kombination von Nivolumab plus Ipilimumab ist beim metastasierten Kolorektalkarzinom mit MSI-H- oder dMMR klar im Vorteil gegenüber einer Nivolumab-Monotherapie: Das Progressionsrisiko war damit in einer Phase-3-Studie um 38% reduziert.

Riesenzellarteriitis: bilaterale Biopsie der Temporalarterien von Vorteil

Die Riesenzellarteriitis (RZA) erfordert eine rasche und präzise Diagnose, da innerhalb weniger Tage ein schwerer, irreversibler Sehverlust drohen kann. In diesem Zusammenhang scheint die bilaterale Biopsie der Temporalarterien (TAB) der unilateralen überlegen zu sein.

Große Trinkmengen bei Blasentumoren möglicherweise von Nachteil

Beim nicht-muskelinvasiven Blasenkrebs scheint eine hohe Flüssigkeitszufuhr keinen schützenden Effekt in Bezug auf das Risiko eines Rezidivs oder einer Krankheitsprogression zu haben. Eine niederländische Studie legt sogar nahe, dass große Trinkmengen das Fortschreiten der Erkrankung begünstigen könnten.

Höhere Trefferquoten bei Brustkrebsscreening dank KI?

Künstliche Intelligenz unterstützt bei der Auswertung von Mammografie-Screenings und senkt somit den Arbeitsaufwand für Radiologen. Wie wirken sich diese Technologien auf die Trefferquote und die Falsch-positiv-Rate aus? Das hat jetzt eine Studie aus Schweden untersucht.

EKG Essentials: EKG befunden mit System (Link öffnet in neuem Fenster)

In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln.
Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.