A One-Year Follow-up Study of Endoluminal Gastroplication (Endocinch) in GERD Patients Refractory to Proton Pump Inhibitor Therapy

Author： Arts J. Lerut T. Rutgeerts P. Sifrim D. Janssens J. Tack J.

Publisher： Springer Publishing Company

ISSN： 0163-2116

Source： Digestive Diseases and Sciences, Vol.50, Iss.2, 2005-02, pp. : 351-356

Disclaimer: Any content in publications that violate the sovereignty, the constitution or regulations of the PRC is not accepted or approved by CNPIEC.

Previous Menu Next

Abstract

In a subset of patients with gastroesophageal reflux disease (GERD), symptoms persist in spite of proton pump inhibitor (PPI) therapy. Endoscopic gastroplication (EG) was reported to provide a novel therapeutic option in GERD. To evaluate symptomatic and objective outcome of EG in PPI refractory GERD, consecutive GERD patients with persisting reflux symptoms during at least 2 months double dose PPI were recruited for EG (Endocinch). Exclusion criteria were high-grade esophagitis, Barrett’s esophagus, and hiatal hernia >3 cm. Symptoms and PPI use were evaluated before and 1, 3, and 12 months after the EG; 24-hr pH monitoring off PPI was performed before and after 3 and 12 months. All data are given as mean ± SD and were analyzed by Student’s t test. Twenty patients (10 females; mean age, 45 ± 11 years) were recruited. Under conscious sedation with midazolam (6 ± 2 mg) and pethidine (53 ± 5 mg), a mean of 2.0 ± 0.2 sutures was applied during a procedure time of 33 ± 6 min. Throat ache and mild epigastric pain for up to 3 days after the procedure were the only adverse events. At 3 and 12 months symptom score (11.6 ± 6 vs. 6.4 ± 3.7 [P < 0.01] and 7.1 ± 4.5 [P < 0.05]) as well as pH monitoring (% time pH < 4: 17.0 ± 1.1 vs. 8.1 ± 5.7% [P < 0.01] and 9.8 ± 4.1% [P < 0.01]) significantly improved. Ph monitoring was normalized (<4% of time) in seven patients after 3 months. PPIs could be stopped in 13 patients, with 2 patients still using H₂-blockers and 1 using cisapride after 3 months. After 12 months only six patients were free of PPI use and pH monitoring was normalized in six patients. We conclude that EG provides short- and medium-term symptomatic and objective relief to a subset of GERD patients refractory to high-dose PPI.