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Sreepad B, Chennupati K, Zeeshan MS, Ramzan Z. Endoscopic Management Options for Gastroesophageal Reflux Disease. Cureus 2024; 16:e62069. [PMID: 38989395 PMCID: PMC11235412 DOI: 10.7759/cureus.62069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/12/2024] Open
Abstract
Gastroesophageal reflux disease (GERD) is a prevalent condition that affects a significant portion of the Western population. Despite its benign pathophysiology, it has the potential to cause serious complications over time, ranging from conditions that are benign, premalignant, and/or malignant. Traditional treatment options include lifestyle measures, anti-secretory medications (e.g., proton pump inhibitor (PPI)), and surgical options (e.g., Nissen and Toupet fundoplication). However, recent studies have revealed long-term side effects of anti-secretory medications. Moreover, surgical options, though effective, are considered invasive and associated with potential complications. In the current age of ongoing research in minimally invasive options, endoscopic treatment of GERD has become popular. As a result, procedures such as radiofrequency treatment and transoral incisionless fundoplication (TIF) have gained FDA approval and are currently being covered by most insurance. In this review article, we will discuss pre-procedural workup, appropriate patient selection, advantages, disadvantages, procedure techniques, and follow-up of patients who undergo various endoscopic treatments for GERD. In addition, we will review the short and long-term success of these techniques in improving quality of life, use of PPI, and improvement in symptoms considering published data in high-quality peer-reviewed journals.
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Affiliation(s)
- Bhavana Sreepad
- Medical School, TCU Burnett School of Medicine, Fort Worth, USA
| | - Karteek Chennupati
- Gastroenterology, Texas Health Harris Methodist Hospital, Fort Worth, USA
| | | | - Zeeshan Ramzan
- Gastroenterology, Texas Health Harris Methodist Hospital, Fort Worth, USA
- Gastroenterology, TCU Burnett School of Medicine, Fort Worth, USA
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2
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Haseeb M, Thompson CC. Endoscopic therapy for gastroesophageal reflux disease: where are we, where are we going? Curr Opin Gastroenterol 2023; 39:381-389. [PMID: 37523156 PMCID: PMC10629818 DOI: 10.1097/mog.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW Gastroesophageal reflux disease (GERD) is the most common chronic condition with increasing prevalence in the Western world. Despite medical therapy, a considerable proportion of patients continue to experience symptoms, thus fueling the demand for minimally invasive GERD treatment options. This review will assess the currently available endoscopic approaches by analyzing their outcomes data, indication for use and limitations. RECENT FINDINGS With increasing evidence of the safety and efficacy of endoscopic therapies, recent guidelines and consensus society documents have updated their recommendations for the endoscopic treatment of GERD. In this review, we have comprehensively assessed the current landscape of endoscopic approaches for the treatment of GERD and provided insight into future directions. SUMMARY Endoscopic therapies for GERD show promise as new treatments emerge and existing therapies evolve into safer and more reproducible options. They are well positioned to cater to a large subset of the population suffering from chronic condition of GERD.
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Affiliation(s)
- Muhammad Haseeb
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Richardson WS, Gorham JK, Neal N, Fanelli RD. Endoscopic Treatment of Gastroesophageal Reflux Disease. Adv Surg 2022; 56:205-227. [PMID: 36096568 DOI: 10.1016/j.yasu.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There have been many devices and ideas to treat reflux disease endoscopically. Several devices have been tried and even FDA approved but now are no longer used. The push for these therapies is to find effective reflux control with lower risk and faster recovery. In this article we describe an endoscopic suturing device (TIF), radiofrequency device (Stretta) and a newer technique that has a lot of promise called antireflux mucosectomy. All these procedures seem to help control reflux at a minimum of morbidity given current information. As reflux is so prevalent a shift to these techniques for appropriate patients is likely to improve patient care.
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Affiliation(s)
- William S Richardson
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA 70121, USA; University of Queensland, Brisbane, Australia.
| | | | - Nicole Neal
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Robert D Fanelli
- Department of Surgery, The Guthrie Clinic, One Guthrie Square, Sayre, PA 18840, USA; Geisinger Commonwealth School of Medicine, Sayre, PA, USA
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4
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Zhang LY, Kalloo AN, Ngamruengphong S. Therapeutic Endoscopy and the Esophagus: State of the Art and Future Directions. Gastroenterol Clin North Am 2021; 50:935-958. [PMID: 34717880 DOI: 10.1016/j.gtc.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Therapeutic gastrointestinal endoscopy is rapidly evolving, and this evolution is quite apparent for esophageal diseases. Minimally invasive endoluminal therapy now allows outpatient treatment of many esophageal diseases that were traditionally managed surgically. In this review article, we explore the most exciting new developments. We discuss the use of peroral endoscopic myotomy for treatment of achalasia and other related diseases, as well as the modifications that have allowed its use in treatment of Zenker diverticulum. We cover endoscopic treatment of gastroesophageal reflux disease and Barrett's esophagus. Further, we explore advanced endoscopic resection techniques.
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Affiliation(s)
- Linda Y Zhang
- Division of Gastroenterology & Hepatology, Johns Hopkins Medicine, 1800 Orleans St, Sheikh Zayed Tower, Suite M2058, Baltimore, MD 21287, USA
| | - Anthony N Kalloo
- Department of Medicine, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA; Department of Medicine, Johns Hopkins Medicine, 1800 Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287, USA
| | - Saowanee Ngamruengphong
- Division of Gastroenterology & Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th Floor, A-501, Baltimore, MD 21224, USA.
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Chen S, Du F, Zhong C, Liu C, Wang X, Chen Y, Wang G, Gao X, Zhang L, Li L, Wu W. Gastroesophageal reflux disease: recent innovations in endoscopic assessment and treatment. Gastroenterol Rep (Oxf) 2021; 9:383-391. [PMID: 34733523 PMCID: PMC8560030 DOI: 10.1093/gastro/goab029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/19/2022] Open
Abstract
Innovations in endoscopy have brought about some impressive improvements in diagnosing and treating gastroesophageal reflux disease (GERD). GERD, as one of the most prevalent gastrointestinal disorders in the world, has always been on the cutting edge of endoscopic interventions. A primary diagnosis of GERD is based on symptoms and an initial trial of proton-pump inhibitor (PPI) therapy, which is devoid of adequately instructive value for therapeutic strategies. Endoscopy and optional biopsies can be used to directly observe and determine the abnormal structural and pathophysiological damage in the esophagus. The emergence of minimally invasive endoscopic therapy fills the gap between patients who are reluctant or insensitive to PPIs and candidates who are not indicated for surgical anti-reflux fundoplication. In this review, we discuss the utility of endoscopy and biopsy in patients with persistent GERD-related manifestations after proper medical anti-reflux treatment. Moreover, we portray a landscape of four current endoscopic GERD therapies and clarify the merits and disadvantages of each technique. Future research needs to concentrate on stratifying GERD patients based on personal conditions and elucidating the primary pathophysiology of GERD.
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Affiliation(s)
- Sheng Chen
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
- State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and Health, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
| | - Feng Du
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
- Department of Internal Medicine, The Hospital of the People's Liberation Army 63650 Corps, Malan, Xinjiang, P. R. China
| | - Changqing Zhong
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
| | - Caifang Liu
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Medical University, Xi’an, Shaanxi, P. R. China
| | - Xiaoying Wang
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
| | - Yan Chen
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
| | - Gang Wang
- State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and Health, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
- Department of Otorhinolaryngology Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
| | - Xiaopei Gao
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
| | - Lu Zhang
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
| | - Lianyong Li
- Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
| | - Wei Wu
- State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and Health, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
- Department of Otorhinolaryngology Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, P. R. China
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Endoscopic approaches to gastroesophageal reflux disease. Curr Opin Gastroenterol 2021; 37:441-448. [PMID: 34265794 DOI: 10.1097/mog.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Gastroesophageal reflux disease (GERD) is one of the most common chronic conditions affecting adults. A substantial proportion of patients continue to have symptoms despite medical therapy, and there has been increased demand for minimally invasive GERD therapy. We will examine currently available techniques and outcomes data on endoscopic approaches to the treatment of GERD. RECENT FINDINGS In the last 2 years, research has given rise to more robust understanding of not only the pathophysiology of GERD but also how to better manage the various phenotypes. We are learning the ideal patient to benefit from endoscopic GERD therapy. In this review, we describe the four major endoluminal techniques for treating GERD and summarize current data. SUMMARY Endoscopic therapies are well positioned to fill the 'therapy gap' between medical therapy and more invasive surgical procedures.
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Jung HY. In Which Situation is Endoscopic Radiofrequency Anti-Reflux Therapy (Stretta) Effective for Controlling Gastroesophageal Reflux Symptoms? Clin Endosc 2021; 54:451-452. [PMID: 34261209 PMCID: PMC8357594 DOI: 10.5946/ce.2021.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Xiao YL, Zhou LY, Hou XH, Li YQ, Zou DW, Chen MH. Chinese expert consensus on gastroesophageal reflux disease in 2020. J Dig Dis 2021; 22:376-389. [PMID: 34105263 DOI: 10.1111/1751-2980.13028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Ying Lian Xiao
- Department of Gastroenterology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Li Ya Zhou
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Xiao Hua Hou
- Department of Gastroenterology, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yan Qing Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Duo Wu Zou
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Min Hu Chen
- Department of Gastroenterology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
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Nevins EJ, Dixon JE, Viswanath YKS. The Outcome of Endoscopic Radiofrequency Anti-Reflux Therapy (STRETTA) for Gastroesophageal Reflux Disease in Patients with Previous Gastric Surgery: A Prospective Cohort Study. Clin Endosc 2021; 54:542-547. [PMID: 33761229 PMCID: PMC8357598 DOI: 10.5946/ce.2020.243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims STRETTA improves the quality of life and reduces the need for anti-reflux medication in select patients, especially those with uncomplicated gastroesophageal reflux disease (GERD). We aimed to review the outcomes of STRETTA in patients with medically refractory GERD, who had undergone previous gastric surgery.
Methods This was a review of a prospective database in a British center. Since 2016, all GERD patients who underwent STRETTA and had a history of previous gastric surgery were studied (n=11). Anti-reflux medication pre- and post-STRETTA was evaluated. The outcomes were assessed objectively by the change in anti-reflux medication and subjectively through a pre- and post-procedure GERD-health-related quality of life (HRQL) questionnaire.
Results The median length of follow-up was 23 months. Nine patients demonstrated improved GERD-HRQL scores following STRETTA (82%). Of the 7 patients who underwent fundoplication, all reported improved symptoms, with 3 patients discontinuing the medication and 3 patients on a reduced dose of proton pump inhibitor. Four patients underwent surgery other than fundoplication, of which 2 reported improvement and discontinued the proton pump inhibitor. Two patients reported no improvement.
Conclusions This study demonstrates that STRETTA is successful in reducing refractory GERD in patients with previous gastric surgery. The outcomes were comparable to published outcomes in patients with uncomplicated GERD with no previous history of gastric surgery.
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Affiliation(s)
- Edward John Nevins
- Department of Upper GI surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - James Edward Dixon
- Department of Upper GI surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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Huynh P, Konda V, Sanguansataya S, Ward MA, Leeds SG. Mind the Gap: Current Treatment Alternatives for GERD Patients Failing Medical Treatment and Not Ready for a Fundoplication. Surg Laparosc Endosc Percutan Tech 2020; 31:264-276. [PMID: 33347088 PMCID: PMC8154178 DOI: 10.1097/sle.0000000000000888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease is associated with Barrett esophagus, esophageal adenocarcinoma, and significantly impacts quality of life. Medical management is the first line therapy with surgical fundoplication as an alternative therapy. However, a small portion of patients who fail medical therapy are referred for surgical consultation. This creates a "gap" in therapy for those patients dissatisfied with medical therapy but are not getting referred for surgical consultation. Three procedures have been designed to address these patients. These include radiofrequency ablation (RFA) of the lower esophageal sphincter, transoral incisionless fundoplication (TIF), and magnetic sphincter augmentation. MATERIALS AND METHODS A Pubmed literature review was conducted of all publications for RFA, TIF, and MSA. Four most common endpoints for the 3 procedures were compared at different intervals of follow-up. These include percent of patients off proton pump inhibitors (PPIs), GERD-HRQL score, DeMeester score, and percent of time with pH <4. A second query was performed for patients treated with PPI and fundoplications to match the same 4 endpoints as a control. RESULTS Variable freedom from PPI was reported at 1 year for RFA with a weighted mean of 62%, TIF with a weighted mean of 61%, MSA with a weighted mean of 85%, and fundoplications with a weighted mean of 84%. All procedures including PPIs improved quality-of-life scores but were not equal. Fundoplication had the best improvement followed by MSA, TIF, RFA, and PPI, respectively. DeMeester scores are variable after all procedures and PPIs. All MSA studies showed normalization of pH, whereas only 4 of 17 RFA studies and 3 of 11 TIF studies reported normalization of pH. CONCLUSIONS Our literature review compares 3 rival procedures to treat "gap" patients for gastroesophageal reflux disease with 4 common endpoints. Magnetic sphincter augmentation appears to have the most reproducible and linear outcomes but is the most invasive of the 3 procedures. MSA outcomes most closely mirrors that of fundoplication.
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Affiliation(s)
- Phuong Huynh
- Division of Minimally Invasive Surgery, Baylor University Medical Center
- Center for Advanced Surgery, Baylor Scott & White Health
| | - Vani Konda
- Center for Esophageal Diseases, Baylor University Medical Center, Dallas
| | | | - Marc A. Ward
- Division of Minimally Invasive Surgery, Baylor University Medical Center
- Center for Advanced Surgery, Baylor Scott & White Health
- Texas A&M College of Medicine, Bryan, TX
| | - Steven G. Leeds
- Division of Minimally Invasive Surgery, Baylor University Medical Center
- Center for Advanced Surgery, Baylor Scott & White Health
- Texas A&M College of Medicine, Bryan, TX
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11
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Fanous M, Jaehne A, Simbob J. The Benefits of Nonablative Radiofrequency Treatment of the Lower Esophageal Sphincter After Transoral Incisionless Fundoplication. Am Surg 2020; 86:1525-1527. [PMID: 32683926 DOI: 10.1177/0003134820933586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Non-ablative radiofrequency treatment to the lower esophageal sphincter (Stretta) has been shown to be beneficial after failed Nissen fundoplication. To our knowledge, this is the first report of Stretta after transoral incisionless fundoplication (TIF). This patient is a 17-year-old female who had gastroesophageal reflux disease (GERD) symptoms for 9 years. She presented with heartburn, regurgitation, and epigastric discomfort. She used omeprazole for 9 years. Esophagogastroduodenoscopy (EGD) showed a 2 cm sliding hiatal hernia and DeMeester score of 25. The GERD Health-Related Quality of Life (GERD-HRQL) score on omeprazole was 14. Patient underwent a TIF procedure, which was uneventful. Her symptoms resolved, and she discontinued omeprazole. Six months later, she had episodes of repeated violent vomiting followed by recurrence of regurgitation, nausea, bloating, and dysphagia. She resumed omeprazole. Diagnostic workup included gastric emptying scan, which was normal. EGD showed no hiatal hernia and partial disruption of the TIF valve. DeMeester score was 36.3. Esophageal manometry with impedance showed intact peristalsis and normal relaxation of the lower esophageal sphincter. The patient underwent Stretta, which was uneventful. The previous TIF did not increase the complexity of the procedure. There were no immediate or postoperative complications. The patient reported gradual improvement of her symptoms with complete resolution 2 months postoperatively. She discontinued omeprazole. The GERD-HRQL score 17 months post-Stretta was 0. This case highlights the feasibility, safety, and efficacy of performing Stretta following TIF. It provides an endoluminal alternative to complex revisional antireflux surgery. Prospective studies with longer follow-up are required to validate this concept.
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Affiliation(s)
- Medhat Fanous
- Department of Surgery, Aspirus Iron River Hospital & Clinics, Iron River, MI, USA
| | - Anja Jaehne
- Department of Quality Assurance, Aspirus Iron River Hospital & Clinics, Iron River, MI, USA
| | - Jenna Simbob
- Surgical Services, Aspirus Iron River Hospital & Clinics, Iron River, MI, USA
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Sowa P, Samarasena JB. Nonablative Radiofrequency Treatment for Gastroesophageal Reflux Disease (STRETTA). Gastrointest Endosc Clin N Am 2020; 30:253-265. [PMID: 32146945 DOI: 10.1016/j.giec.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gastroesophageal reflux disease (GERD) is the most frequent outpatient diagnosis in the United States. There has been significant development in the endoscopic treatment of GERD, with several devices that have reached the market. One of the endoscopic devices for the management of GERD in the United States is the Stretta system. This procedure uses radiofrequency energy, which is applied to the muscles of the lower esophageal sphincter and the gastric cardia resulting in an improvement of reflux symptoms. This review evaluates the most recent data on the efficacy, mechanisms of action, and safety of this procedure.
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Affiliation(s)
- Piotr Sowa
- University of California - Irvine, Orange, CA, USA
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Omentopexy in Sleeve Gastrectomy Reduces Early Gastroesophageal Reflux Symptoms. Surg Laparosc Endosc Percutan Tech 2019; 29:155-161. [PMID: 30499891 DOI: 10.1097/sle.0000000000000597] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is one of the surgical procedures indicated in the treatment of obesity. The occurrence of gastroesophageal reflux (GER) in the postoperative period of this surgery is related to a reduction in the lower esophageal sphincter (LES) tone and the presence of gastric residual fundus (RF) associated with increased gastric intraluminal pressure. Fixation of the remaining gastric reservoir to the gastrosplenic and gastrocolic ligaments (omentopexy) has emerged as a technical option to avoid or decrease GER in the postoperative period of LSG. OBJECTIVE To evaluate the presence of GER symptoms, alterations in LES tone, and the presence of RF in obese subjects submitted to LSG with omentopexy. METHODS Twenty obese patients were submitted to LSG with omentopexy from July 2016 to July 2017 at the Hospital Unimed de Teresina, Brazil and was studied prospectively. Clinical evaluations, including a specific questionnaire (clinical score), upper digestive endoscopy and esophageal manometry, were performed preoperatively and on the 90th postoperative day. Contrast x-ray of the esophagus, stomach, and duodenum were performed after the 90th postoperative day. The Fischer exact test was used to evaluate the correlation between GER symptoms and changes in LES tone or the presence of RF. Analysis of variance was used to evaluate the correlation of GER symptoms with the 2 variables together. All analyses adopted a level of significance for α errors >5% (P-value <0.05). RESULTS The mean clinical score of GER reduced from 6.7 in the preoperative period to 2.7 in the postoperative period. By manometry, there were no significant changes in the LES tone with mean values of 26.04 and 27.07 mm Hg before and after the procedure. RF was identified in 3 cases by contrast radiology. There was no statistical correlation between the changes in the LES tone or the presence of RF with the increase in the clinical score of GER (in cases where this occurred), even when the variables were evaluated together. CONCLUSIONS LSG with omentopexy improved the clinical score of GER in most cases and did not cause significant changes in the LES tone. The presence of RF did not exacerbate the clinical score of GER.
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Haddad A, Bashir A, Nimeri A. Gastrogastric Fistula: an Unusual Cause for Severe Bile Reflux Following Conversion of Sleeve Gastrectomy to One Anastomosis Gastric Bypass. Obes Surg 2019; 28:2151-2153. [PMID: 29728987 DOI: 10.1007/s11695-018-3288-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION One anastomosis gastric bypass/mini-gastric bypass (OAGB/MGB) was first described in 2001 as a safe and effective procedure. It has been gaining popularity worldwide. Multiple authors have reported the need to re-operate on patients for bile reflux. We report a patient with severe bile reflux after laparoscopic conversion of sleeve gastrectomy (LSG) to OAGB/MGB. METHODS A 33-year-old patient underwent a LSG in 2014. Postoperatively, she developed severe gastroesophageal acid reflux. In 2016, she underwent conversion of LSG to OAGB/MGB at the original institution for the treatment of her reflux symptoms. In 2017, she presented to us with epigastric pain, worsening reflux symptoms, steatorrhea, hypoproteinemia (6 g/dl), and body mass index of 25 kg/m2. Preoperative endoscopy revealed bile reflux, suture bezoar, and ulceration at the anastomosis. TECHNIQUE Laparoscopic exploration started by identifying the anatomy and measuring the lengths of the biliopancreatic limb (350 cm) and the common channel (450 cm). Upon dissecting the pouch, a gastrogastric fistula extending from the antrum to the pouch was encountered. This was confirmed with intraoperative endoscopy with bile refluxing to the pouch. The fistula, antrum, and part of the pouch were resected. The patient was converted to Roux-en-Y gastric bypass. She had an uneventful postoperative recovery. At 3 months of follow-up, her weight was stable and her steatorrhea resolved. CONCLUSION Patients with bile reflux after OAGB/MGB need a high index of suspicion to detect unusual causes. Gastrogastric fistula is an unusual etiology of bile reflux that was never reported in the literature previously.
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Affiliation(s)
- Ashraf Haddad
- Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC) -Jordan Hospital, Queen Noor St., 4th Circle, 3073, Amman, 11181, Jordan.
| | - Ahmad Bashir
- Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC) -Jordan Hospital, Queen Noor St., 4th Circle, 3073, Amman, 11181, Jordan
| | - Abdelrahman Nimeri
- Bariatric & Metabolic Institute (BMI), Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Viswanath YKS, Maguire N, Obuobi RB, Dhar A, Punnoose S. Endoscopic day case antireflux radiofrequency (Stretta) therapy improves quality of life and reduce proton pump inhibitor (PPI) dependency in patients with gastro-oesophageal reflux disease: a prospective study from a UK tertiary centre. Frontline Gastroenterol 2019; 10:113-119. [PMID: 31205650 PMCID: PMC6540282 DOI: 10.1136/flgastro-2018-101028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/31/2018] [Accepted: 08/19/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic antireflux radiofrequency treatment (Stretta) offers a therapeutic alternative for patients suffering from refractory gastro-oesophageal reflux disease (GORD). Current evidence suggests that the treatment may improve symptoms of GORD and decrease requirement for proton pump inhibitor (PPI) therapy. METHODS Prospective assessment of patients undergoing Stretta, between October 2014 and February 2016, in a UK tertiary referral centre was carried. All patients were assessed for suitability using endoscopy, contrast studies, and pH and manometry studies. The Gastro-oesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) was used to evaluate symptoms along with PPI dependency, pre-Stretta and post-Stretta treatment. Patients were followed up by outpatient clinic appointment and telephone consultation. RESULTS Fifty consecutive patients were followed up for a median of 771 days (range 499-1162) following treatment with Stretta. The average GERD-HRQL score improved from 46.2/75 (±14.2) preprocedure to 15.2/75 (±17.3) postprocedure. Dissatisfaction with GORD as measured in the GERD-HRQL decreased from 100% to 10% with three patients showing no improvement (non-responders) at follow up and two late failures at the time of this review. There were no complications and all cases were carried out as day cases. CONCLUSION There are currently few effective therapeutic alternatives to antireflux surgery for refractory GORD. This series corroborates the value and safety of Stretta as a viable option for selected patients who are unwilling or unable to undergo an operation. Stretta improves quality of life and decreases PPI dependency in selected patients with GORD.
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Affiliation(s)
- YKS Viswanath
- Upper GI Laparoscopic and endoscopic surgery, James Cook University Hospital, Middlesbrough, Cleveland, UK
| | - Nicola Maguire
- Upper GI Laparoscopic and endoscopic surgery, James Cook University Hospital, Middlesbrough, Cleveland, UK
| | - Reece-Bolton Obuobi
- Upper GI Laparoscopic and endoscopic surgery, James Cook University Hospital, Middlesbrough, Cleveland, UK
| | - Anjan Dhar
- Darlington Memorial Hospital, Bishop Auckland, UK
| | - Siby Punnoose
- Darlington Memorial Hospital, Bishop Auckland, UK,Gastroenterology, County Durham & Darlington NHS FoundationTrust
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16
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Souza TFD, Grecco E, Quadros LGD, Albuquerque YDD, Azôr FO, Galvão Neto M. SHORT-TERM RESULTS OF MINIMALLY INVASIVE TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE BY RADIOFREQUENCY (STRETTA): FIRST BRAZILIAN SERIES OF CASES. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55Suppl 1:52-55. [PMID: 30517356 DOI: 10.1590/s0004-2803.201800000-51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/25/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND New endoscopic treatments for gastroesophageal reflux (GERD) are developed every year and are indicated in cases that are refractory to conventional therapies as well as after surgical treatment failure. OBJECTIVE To present the first cases of endoscopic therapy for GERD performed in Brazil. METHODS Use of radiofrequency with the Stretta procedure in symptomatic volunteers diagnosed with GERD. RESULTS The technique was performed in three patients after they were included in the study protocol. No patient had complications, and all patients were discharged on the same day, either without medication or taking it sporadically for symptom control. CONCLUSION Endoscopic treatment for GERD using radiofrequency was effective in the cases presented herein with no technical complications.
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Affiliation(s)
- Thiago Ferreira de Souza
- Instituto Endovitta, São Paulo, SP, Brasil.,Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Eduardo Grecco
- Instituto Endovitta, São Paulo, SP, Brasil.,Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | | | | | | | - Manoel Galvão Neto
- Instituto Endovitta, São Paulo, SP, Brasil.,Faculdade de Medicina do ABC, Santo André, SP, Brasil
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17
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Mayor MA, Fernando HC. Endoluminal Approaches to Gastroesophageal Reflux Disease. Thorac Surg Clin 2018; 28:527-532. [DOI: 10.1016/j.thorsurg.2018.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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18
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Abstract
PURPOSE OF REVIEW Nearly, a third of patients with medically refractory gastroesophageal reflux disease (GERD) will desire an additional nonsurgical treatment option. Recently, endoscopic therapy has been reintroduced as a minimally invasive antireflux barrier treatment, after addressing prior efficacy and safety concerns. Over the last two decades, additional experience and new technologies have resulted in devices and protocols with favorable short-term outcomes and safety profiles. The current literature in endoscopic antireflux therapies covers new devices, long-term follow-up data and further safety experience. This review discusses the endoscopic antireflux devices on the market and most recent studies in this area. RECENT FINDINGS Quality of life and reflux symptom score improvement is observed in 73-90% of patients through a 36-48 month follow-up period, with 41-77% remaining off all reflux medicines. Composite data from several thousand cases indicate a low rate (0.93-2.4%) of serious complications and no late adverse effects, including gas-bloat syndrome. SUMMARY In this review, we describe the four endoscopic antireflux devices on market and summarize the current data in the literature. The short and long-term data demonstrate durable symptom improvement and favorable safety profile. Endoscopic antireflux treatment should be considered in the management of GERD.
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19
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Rouphael C, Padival R, Sanaka MR, Thota PN. Endoscopic Treatments of GERD. ACTA ACUST UNITED AC 2018; 16:58-71. [DOI: 10.1007/s11938-018-0170-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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