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Der Plicator – Die endoskopische Lösung der Antirefluxtherapie?

The plicator – the endoscopic solution for anti-reflux therapy?

  • Schwerpunkt: Neue Techniken in der Endoskopie
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Sodbrennen, das am häufigsten vorkommende Symptom der GERD, tritt bei 10–20% der US-amerikanischen und westeuropäischen Bevölkerung auf. Die PPI-Therapie muss meist lebenslang durchgeführt werden, da die Symptome nach Absetzen fast immer rezidivieren. Nebenwirkungen oder ein symptomatischer nichtsaurer Reflux können auftreten. Neben endoskopischen Nahttechniken wurden Injektions-/Implantationsverfahren von Biopolymeren und die Radiofrequenztherapie erprobt. Die meisten sind aufgrund mangelnder Wirksamkeit oder schwerwiegender Nebenwirkungen wieder aufgegeben worden. Da es bei endoluminalen Nahtverfahren der ersten Generation häufig zu Nahtverlusten kam, wurde das transmurale Nahtsystem PlicatorTM entwickelt. In einer prospektiv randomisierten, placebokontrollierten-Studie konnte eine signifikante Verbesserung hinsichtlich Beschwerden, Medikamentenverbrauch und pH-Metrie-Daten gezeigt werden. Technische Weiterentwicklungen wie die Verwendung von 2 Nähten werden zurzeit evaluiert.

Abstract

Heartburn, the most common symptom associated with gastro-esophageal reflux disease (GERD), occurs in 10–20% of the US and western European populations. Life-long proton-pump inhibitor (PPI) therapy for GERD is often required since symptoms typically recur once therapy has been discontinued. Moreover, a number of patients on PPI treatment will experience side effects or symptomatic non-acidic regurgitation. Several endoscopic anti-reflux procedures have been developed including the injection or implantation of biopolymers and radiofrequency therapy. Most of the techniques have been abandoned due to lack of long-term efficacy or serious side effects. Since first generation endoluminal suturing techniques showed insufficient durability due to suture loss, the transmural plication technique Plicator was developed. In a prospective, randomized, sham-controlled trial use of the Plicator led to an improvement in reflux symptoms, medication use and esophageal acid exposure. Further technical improvements such as the use of two sutures are currently being investigated.

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Interessenkonflikt

Es besteht eine Zusammenarbeit der Medizinischen Klinik 1 des Klinikum Ludwigsburg mit der Firma NDO-Surgical bezüglich weiterer Plicator-Studien. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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  1. Medizinische Klinik I, Klinikum Ludwigsburg, Posilipostraße 1, 71640, Ludwigsburg, Deutschland

    D. von Renteln &  Karel Caca

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  1. D. von Renteln
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  2. Karel Caca
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Correspondence to Karel Caca.

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von Renteln, D., Caca, K. Der Plicator – Die endoskopische Lösung der Antirefluxtherapie?. Gastroenterologe 2, 110–117 (2007). https://doi.org/10.1007/s11377-006-0070-5

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  • DOI: https://doi.org/10.1007/s11377-006-0070-5

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