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 - 20/12/12
Reprint requests: Oliver Owen Koch, MD, Department of General Surgery, General Hospital Zell am See, Paracelsusstrasse 8, A-5700 Zell am See, AustriaRésumé |
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%20Trial%20registration%20number: NCT01453985.)
Le texte complet de cet article est disponible en PDF.Abbreviations : GIQLI, LARS, LES, MII, PPI, QoL, SI
Plan
| DISCLOSURE: The authors disclosed no financial relationships relevant to this publication. |
Vol 77 - N° 1
P. 7-14 - janvier 2013 Retour au numéro
Article précédent
- Small-bowel endoscopy core curriculum
- ASGE Training Committee 2011-2012, Elizabeth A. Rajan, Shireen A. Pais, Barry T. DeGregorio, Douglas G. Adler, Mohammad Al-Haddad, Gennadiy Bakis, Walter J. Coyle, Raquel E. Davila, Christopher J. DiMaio, Brintha K. Enestvedt, Jennifer Jorgensen, Linda S. Lee, Daniel K. Mullady, Keith L. Obstein, Robert E. Sedlack, William M. Tierney, Ashley L. Faulx
- Endoscopic full-thickness plication for the treatment of GERD: is there a future?
- Hubert Louis
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