Original article Clinical endoscopy| Volume 77, ISSUE 1, P7-14, January 2013

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Subjective and objective data on esophageal manometry and impedance pH monitoring 1 year after endoscopic full-thickness plication for the treatment of GERD by using multiple plication implants

Published:September 28, 2012DOI:


      Subjective and especially objective data after endoluminal full-thickness gastroplication are scarce.


      To evaluate symptoms and reflux activity 12 months after gastroplication by using multichannel intraluminal impedance monitoring.


      Open-label, prospective, single-center study.


      Tertiary referral hospital in Zell am See, Austria.


      Subjects without hiatal hernias with documented GERD and persistent or recurrent symptoms despite treatment with a proton pump inhibitor.


      A total of 36 patients underwent endoscopic full-thickness gastroplication with 1 or more Plicator implants.

      Main Outcome Measurements

      Mean Gastrointestinal Quality of Life Index and reflux-specific symptom scores significantly improved on follow-up (P < .01). Atypical reflux, gas/bloating, and bowel dysfunction–specific symptom scores as well as belching and dysphagia scores improved. Twenty-two patients returned for esophageal manometry and multichannel intraluminal impedance testing 1 year after surgery. DeMeester scores decreased from 20 to 10 (P < .029). The median numbers of total, acid, proximal, upright, and recumbent reflux episodes were all significantly reduced (P < .05). Manometric data were virtually unchanged. The percentage of patients taking proton pump inhibitors on daily basis after the procedure was 11.5%. There was only 1 postprocedure incident (bleeding) that required intervention. Three of 36 patients (8.3%) were considered treatment failures because of persistent symptoms and were assigned to undergo laparoscopic fundoplication.


      No randomized comparison with a sham procedure or laparoscopic fundoplication; follow-up interval.


      Endoscopic plication is safe and improves objective and subjective parameters at 1-year follow-up, without side effects seen after laparoscopic fundoplication. Further studies on the clinical merit of this procedure in specific patient populations are warranted. (Clinical Trial registration number: NCT01453985.)


      GIQLI (Gastrointestinal Quality of Life Index), LARS (laparoscopic antireflux surgery), LES (lower esophageal sphincter), MII (multichannel intraluminal impedance), PPI (proton pump inhibitor), QoL (quality of life), SI (Symptom Index)
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      Linked Article

      • Symptom association analysis is important in GERD patients undergoing endoscopic therapy
        Gastrointestinal EndoscopyVol. 77Issue 5
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          We read the article by Koch et al1 on the safety and efficacy of endoluminal full-thickness gastroplication (the Plicator) in patients with GERD. The authors evaluated 36 patients who were refractory to proton pump inhibitors (PPIs), using impedance pH off-therapy before and after gastroplication (n = 20). GERD was diagnosed in case of (1) total number of reflux events >73, (2) composite pH DeMeester score >14.7, or (3) positive symptom index (SI) for symptoms reported at least 3 times. The Plicator significantly improved quality of life and reflux symptoms and markedly reduced esophageal acid exposure time, proximal migration of refluxate, and both acidic reflux and weakly acidic reflux (WAR) events.
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