经口内镜贲门缩窄术联合伏诺拉生对全周型巴雷特食管的临床疗效分析

Clinical efficacy analysis of peroral endoscopic cardial constriction combined with vonoprazan for circumferential type of Barrett esophagus

摘要:

目的 比较经口内镜贲门缩窄术（PECC）联合伏诺拉生与伏诺拉生联合多潘立酮两种方案治疗全周型巴雷特食管（CBE）的临床效果，重点评估两种治疗方案对反流症状及早期食管黏膜愈合的影响。方法 回顾性收集2023年1月－2025年10月于该院就诊的60例CBE患者的临床资料。根据实际接受的治疗方案分为研究组和对照组，每组30例。研究组采用PECC联合伏诺拉生治疗，对照组采用伏诺拉生联合多潘立酮治疗。比较两组患者治疗前和治疗后6个月的胃食管反流病问卷量表（GerdQ）评分、24 h食管pH监测参数（胃食管反流积分和最长反流持续时间），以及内镜下食管黏膜愈合情况，比较两组患者治疗总有效率及治疗后6个月内症状复发率。结果 研究组治疗总有效率高于对照组，差异有统计学意义（P < 0.05）。治疗后6个月，研究组GerdQ评分和胃食管反流积分明显低于对照组，最长反流持续时间明显短于对照组，食管下段括约肌压力（LESP）明显高于对照组，差异均有统计学意义（P < 0.05）。研究组食管黏膜愈合率明显高于对照组，且治疗后6个月内症状复发率明显低于对照组，差异均有统计学意义（P < 0.05）。结论 与伏诺拉生联合多潘立酮治疗相比，PECC联合伏诺拉生治疗CBE在改善反流症状、促进早期食管黏膜愈合及降低短期症状复发率方面具备一定优势，具有一定的临床应用价值。

Abstract:

Objective To compare the clinical efficacy of peroral endoscopic cardial constriction (PECC) combined with vonoprazan versus vonoprazan combined with domperidone for circumferential type of Barrett esophagus (CBE), with particular emphasis on their effects on reflux symptoms and early esophageal mucosal healing.Methods Clinical data of 60 patients with CBE treated between January 2023 and October 2025 were retrospectively collected. According to the treatment actually received, the patients were divided into a study group and a control group, with 30 patients in each group. The study group received PECC combined with vonoprazan, whereas the control group received vonoprazan combined with domperidone. Baseline characteristics, gastroesophageal reflux disease questionnaire (GerdQ) scores, 24-h esophageal pH monitoring parameters (DeMeester score and longest reflux duration), and endoscopic esophageal mucosal healing before treatment and after 6 months of treatment were compared between the two groups. The overall response rate and symptom recurrence rate within 6 months after treatment were also compared.Results The overall response rate was higher in the study group than in the control group, and the difference was statistically significant (P < 0.05). At 6 months post-treatment, the study group exhibited lower GerdQ scores and lower DeMeester scores compared to the control group, the maximum reflux duration was significantly shorter in the study group than that in the control group; and the lower esophageal sphincter pressure (LESP) value was significantly higher in the study group than that in the control group, the differences were statistically significant (P < 0.05). The esophageal mucosal healing rate was higher in the study group, whereas the symptom recurrence rate was lower than that in the control group, the differences were statistically significant (P < 0.05).Conclusion Compared with vonoprazan combined with domperidone, PECC combined with vonoprazan shows advantages in improving reflux symptoms, promoting early esophageal mucosal healing, and reducing short-term symptom recurrence in patients with CBE, possesses significant clinical application value.