| 抄録 |
Although endoscopy is not indicated for initial investigation of patients with typical gastroesophageal reflux symptoms, endoscopy plays a significant role in the evaluation of cases that present with alarm symptoms such as odynophagia, recurrent vomiting, occult gastrointestinal bleeding, dysphagia, anemia, involuntary weight loss, or extra-esophageal symptoms, and in the follow-up investigation of patients following failed pharmacotherapy, and patients with history of severe erosive esophagitis or Barrett’s esophagus. The value of endoscopy in these subgroups of gastroesophageal reflux patients is well recognized for its high yields of clinically significant findings which may include findings of malignant lesions, peptic stricture, peptic ulcer and Barrett metaplasia/dysplasia. The value of endoscopy in gastroesophageal reflux patients is set to increase with the advent of several advanced endoscopic imaging systems such as high resolution endoscopy with or without narrow-band imaging, confocal laser endomicroscopy, and Raman spectroscopy, among others. These imaging modalities enable more detailed visualization of the gastroesophageal mucosa, allowing even microscopic investigation of the mucosa in real time. Already confocal endomicroscopy is helping endoscopists to detect minimally erosive esophagitis in non-erosive reflux disease. In the case of Raman spectroscopy, molecular differentiation of mucosal cells is made possible by the distinguishing spectrum emitted by diseased cells, as compared to normal cells. In addition to diagnostic applications, an increasing role of endoscopy in the intervention of gastroesophageal reflux disease is anticipated with the latest introduction of natural orifice endoluminal anti-reflux procedures enabled by novel devices such as the LINXTM Reflux Management System and the MASTER robotic endosurgical system. With newer generation anti-reflux devices promising better and safer treatment for patients, endoscopic treatment of gastroesophageal reflux disease will likely become more acceptable. |
