Three types of intestinal loops were used to reestablish the internal drainage of bile in 17 cases. The leeway derived from the peristaltic cycle of the intestinal loop for gastrointestinal reflux pressure, the cholangeitis after operation from reflux following choladocho-intestinal anastomosis could be avoided, and, naturally it had changed the traditional method of purèly blockade of the reflux, thus the result from treatment was far more satisfactory.
ObjectiveTo investigate the anti-reflux effect of the conventional esophagogastrostomy with modified Nissen fundoplication in the carcinoma of esophagogastric junction. MethodsSixty patients with carcinoma of esophagogastric junction were divided into two groups including conventional esophagogastrostomy (a group A) and modified fundopication added conventional anastomosis (a group B) in our hospital from November 2011 through November 2013. There were 45 males and 14 females at age of 61.6 (40-73) years. Thirty-nine esophagectomized patients were invited for operative follow-up including reflux disease questionnaire (RDQ) of esophageal reflux symptoms and endoscopy from postoperative 6 months to 1 year. The operative mortality and incidence of complication were obtained from hospital record. ResultsThere was no statistical difference in the operative mortality and incidence of complication between the group A and the group B (P>0.05). The scores of esophageal reflux symptoms and incidence of score of RDQ>12 in the group B were significantly lower than those in the group A (P < 0.05). Anastomotic stenosis was not observed in the two groups by endoscopy. Although no difference in the incidence of reflux esophagitis was found between the two groups (P=0.122), the score of reflux esophagitis in the group B was evidently declined compared with that in the group A (P=0.032). ConclusionModified Nissen fundoplication following conventional esophagogastrostomy in carcinoma of esophagogastic junction may be conveniently performed with effect of reducing gastroesophageal reflux. It's long-term effect of anti-reflux need to be observed in future.
Gastroesophageal reflux disease (GERD) is a common, chronic disease of the digestive system. In recent years, endoluminal therapy for GERD has become a research hotspot. The reduced anti-reflux barrier function plays an important role in the occurrence of GERD. Peroral endoscopic therapy can improve the defect of anti-reflux barrier function. According to the involved layers, the endoscopic therapy can be classified as transmural which represented by transoral incisionless and transoral incisionless fundoplication, and non-transmural which represented by peroral endoscopic cardia constriction and radiofrequency ablation. This article reviews the progress of endoscopic non-full-thickness therapy for GERD in recent years, and introduces the action mechanism of peroral endoscopic therapy of GERD, the therapy of the mucosal layer and muscle layer of anti-reflux barrier, and other treatments. The purpose is to provide a reference for further exploring suitable endoscopic treatment of GERD.