Endoluminal gastroplication for treatment of patients with classic gastroesophageal reflux symptoms and borderline 24-h pH studies

• Published in: Scandinavian journal of gastroenterology 2004-07, Vol.39 (7), p.615-620
• Main Authors: Liu, J. J., Carr-Locke, D. L., Lee, L. S., Brooks, D. C., Saltzman, J. R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ambulatory pH monitoring; Biological and medical sciences; endoscopy; Esophagogastric Junction - surgery; Esophagus; Esophagus - physiopathology; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - surgery; gastroesophageal reflux disease; Gastroscopy - methods; Heartburn - etiology; Heartburn - prevention & control; Humans; Hydrogen-Ion Concentration; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Prospective Studies; Suture Techniques; treatment; Treatment Outcome
• ISSN: 0036-5521; 1502-7708
• DOI: 10.1080/00365520410005063

Background: Patients with classic gastroesophageal reflux disease (GERD) symptoms and borderline 24-h pH studies are not considered to be good candidates for surgical fundoplication. Endoluminal gastroplication (ELGP) is a new endoscopic treatment for patients with GERD. The aim of this study was to evaluate the efficacy of ELGP in these patients. Methods: Patients with heartburn, regurgitation symptoms and a DeMeester score of less than 30 were studied. ELGP involved placement of two or three plications within 2 cm of the gastroesophageal junction. Clinical outcomes measured were heartburn symptom score (HSS), regurgitation frequency score (RFS) and medication use. Results: Twenty-five patients (11 M, 14 F, mean age of 51 years) had a medication use of 11.5 doses of proton-pump inhibitors per week prior to ELGP. Average lower esophageal sphincter pressure measured 15 ± 8 mmHg, and average DeMeester score was 18 ± 8. Nine patients had hiatal hernias and 11 had esophagitis. Twenty-four patients were available for a mean follow-up of 12 months. HSS significantly decreased from 48 to 17 (P < 0.01) and RFS was reduced from 1.8 to 0.7 (P < 0.01). Proton-pump inhibitor use was 5.3 doses per week (P < 0.01) post-ELGP; 12 patients (50%) were off medications, 3 (13%) had a 50% reduction in medication use, and in 9 (37%) there was no change. Complications were bleeding in one patient and aspiration pneumonia in another patient. Conclusions: Endoluminal gastroplication provides symptomatic relief for patients with classic GERD symptoms despite medical therapy and borderline 24-h pH studies.