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.
Gastrointest Endosc 2013;
77:7-14. [PMID:
23021166 DOI:
10.1016/j.gie.2012.07.033]
[Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 07/19/2012] [Indexed: 02/08/2023]
Abstract
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.
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