Background
Subjective and especially objective data after endoluminal full-thickness gastroplication
are scarce.
Objective
To evaluate symptoms and reflux activity 12 months after gastroplication by using
multichannel intraluminal impedance monitoring.
Design
Open-label, prospective, single-center study.
Setting
Tertiary referral hospital in Zell am See, Austria.
Patients
Subjects without hiatal hernias with documented GERD and persistent or recurrent symptoms
despite treatment with a proton pump inhibitor.
Interventions
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.
Limitations
No randomized comparison with a sham procedure or laparoscopic fundoplication; follow-up
interval.
Conclusions
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.)
Abbreviations:
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 28, 2012
Accepted:
July 19,
2012
Received:
February 16,
2012
Footnotes
DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Symptom association analysis is important in GERD patients undergoing endoscopic therapyGastrointestinal EndoscopyVol. 77Issue 5
- PreviewWe 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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