A novel modified endoscopic method for treating patients with refractory gastro-esophageal disease and moderate hiatus hernia

Background and aim: endoscopic anti-reflux mucosectomy (ARMS) is effective for patients with refractory gastroesophageal reflux disease (rGERD) with small hiatus hernia. However, evidence of its applicability in patients with larger hernia sac is lacking. This study aimed to evaluate the efficiency and safety of ARMS for patients with rGERD with moderate hiatus hernia (3-5 cm) and determine the appropriate resection range. Methods: thirty-six patients with rGERD with moderate hiatus hernia were enrolled. They were divided into 2/3 and 3/4 circumferential mucosal resection groups. The patients received modified ARMS. The gastroesophageal reflux disease questionnaire (GERD-Q) and DeMeester scores, endoscopy, 24-h pH monitoring results and lower esophageal sphincter (LES) resting pressure were compared pre- and post-procedure. Therapeutic effects and complications of the two mucosal resection ranges were analyzed. Results: thirty-six patients were enrolled in this study, all of whom had undergone ARMS surgery with at least six-month follow-up. In the 2/3 circumferential mucosal resection group, the GERD-Q score, acid exposure time (AET) and DeMeester score improved significantly compared with those before surgery (p < 0.001). In the 3/4 circumferential mucosal resection group, the GERD-Q score, AET and DeMeeter score worsened after six months (p < 0.001), but there was no difference between the two groups (p > 0.05). In both groups, there was no significant improvement in the ratio of esophagitis grade C/D and LES resting pressure after treatment compared with the baseline values (p > 0.05), and no postoperative bleeding or perforation was observed. The incidence of postoperative esophageal stenosis in the 2/3 circumferential mucosal resection group was lower than that in the 3/4 circumferential mucosal resection group (p = 0.041). (AU)

A novel modified endoscopic method for treating patients with refractory gastro-esophageal disease and moderate hiatus hernia.

BACKGROUND AND AIM: endoscopic anti-reflux mucosectomy (ARMS) is effective for patients with refractory gastroesophageal reflux disease (rGERD) with small hiatus hernia. However, evidence of its applicability in patients with larger hernia sac is lacking. This study aimed to evaluate the efficiency and safety of ARMS for patients with rGERD with moderate hiatus hernia (3-5 cm) and determine the appropriate resection range. METHODS: thirty-six patients with rGERD with moderate hiatus hernia were enrolled. They were divided into 2/3 and 3/4 circumferential mucosal resection groups. The patients received modified ARMS. The gastroesophageal reflux disease questionnaire (GERD-Q) and DeMeester scores, endoscopy, 24-h pH monitoring results and lower esophageal sphincter (LES) resting pressure were compared pre- and post-procedure. Therapeutic effects and complications of the two mucosal resection ranges were analyzed. RESULTS: thirty-six patients were enrolled in this study, all of whom had undergone ARMS surgery with at least six-month follow-up. In the 2/3 circumferential mucosal resection group, the GERD-Q score, acid exposure time (AET) and DeMeester score improved significantly compared with those before surgery (p < 0.001). In the 3/4 circumferential mucosal resection group, the GERD-Q score, AET and DeMeeter score worsened after six months (p < 0.001), but there was no difference between the two groups (p > 0.05). In both groups, there was no significant improvement in the ratio of esophagitis grade C/D and LES resting pressure after treatment compared with the baseline values (p > 0.05), and no postoperative bleeding or perforation was observed. The incidence of postoperative esophageal stenosis in the 2/3 circumferential mucosal resection group was lower than that in the 3/4 circumferential mucosal resection group (p = 0.041). CONCLUSION: modified ARMS is effective for patients with rGERD with moderate hiatus hernia, but it cannot significantly increase the postoperative resting pressure of the LES. The 2/3 circumferential mucosal resection can reduce the incidence of postoperative esophageal stenosis.

MUC1 and maltose­binding protein recombinant fusion protein combined with Bacillus Calmette­Guerin induces MUC1­specific and nonspecific anti­tumor immunity in mice.

Human mucin 1 (MUC1) is a target for immunotherapy. The major problem associated with MUC1­based cancer vaccines is the weakness of the immunogenicity of MUC1. The present study aimed to develop an efficient cancer vaccine through generating a recombinant fusion protein consisting of MUC1 and maltose­binding protein (MBP) by inserting seven tandem repeats encoding the human MUC1 gene into the pMAL­c2 expression vector. Bacillus Calmette­Guerin (BCG) was used as an adjuvant. MUC1 was found to predominantly induce T helper type 2 (Th2) cell responses. MUC1/BCG and MUC1­MBP were found to generate T helper (Th) type 1 and 2 responses, while MUC1­MBP/BCG induced a Th1 immune profile and stimulated MUC1­specific cytotoxic T lymphocyte killing activity. MUC1­MBP, as well as MBP and BCG alone were found to induce natural killer (NK) cell activity, with MUC1­MBP/BCG observed to synergistically induce NK cell activity. Furthermore, MUC1­MBP/BCG significantly inhibited MUC1+ B16 cell growth in mice. These findings show that MBP augments the immunogenicity of MUC1 and that BCG enhances the efficacy of the MUC1­MBP vaccine. Thus, MUC1­MBP/BCG may have potential as a cancer vaccine for clinical application.