胃食道逆流症に対する内視鏡的治療

Endoscopic Treatment for Gastroesophageal Reflux Disese

要旨　胃食道逆流症に対する内視鏡的治療には現在6種類の方法があり，3つのカテゴリーに分類できる．第1のカテゴリーは噴門部に皺襞を形成する方法でEndoCinch法（endoluminal gastroplication ; ELGP法），full thickness plicator法，endoscopic suturing device法（ESD法）が，第2のカテゴリーはLES領域の筋層を変性させる方法でStretta法が，第3のカテゴリーはLES領域に異物を挿入する方法でEnteryx法とGatekeeper法がある．治療成績については，症状と酸逆流の改善はほぼすべての方法で認められるが，食道内圧所見まで改善しているのは第3のカテゴリーである．PPI中止率は70％前後の成績が多い．Enteryx法は安全性の問題で2005年9月から使用できなくなった．今後は有効性，安全性，耐久性，費用対効果，適応などのさらなる検討が重要である．

　There are six available endoscopic treatments for gastroesophageal reflux disease (GERD). Plicating gastric folds methods, like the EndoCinch^TM method (Endoscopic Gastroplication, ELGP method), Full-thickness Plicator^TM method, and Endoscopic Suturing Device (ESD) method, are used to form new plications in the cardia. Alternatively, thermal tissue remodeling/neurolysis methods, like Stretta^® System, can be used to denature the muscular layer of the lower esophageal sphincter (LES) region. Finally, bulking injection methods, like Enteryx^® Procedure and Gatekeeper^TM Reflux Repair System, can be used to insert a foreign body into the LES region. All six methods resulted in the improvement of symptoms and acid reflux, but only the bulking injection methods caused an improvement of the manometric findings. The overall discontinuation of the proton-pump inhibitor use has been about 70％. Thus, endoscopic treatments for GERD are still in the developmental phase. Boston Scientific Corporation initiated a voluntary recall of all Enteryx^® devices because of safety issues, in September, 2005. It will not be available for a while. The efficacy, safety, durability, cost-effectiveness, and indications must be thoroughly assessed in clinical trials. If the usefulness of endoscopic treatment is confirmed, however, a new minimally invasive treatment strategy for GERD will have been established.