Endoluminal gastroplication for treatment of patients with classic gastroesophageal reflux symptoms and borderline 24‐h pH studies

Abstract

Background: Patients with classic gastroesophageal reflux disease (GERD) symptoms and borderline 24‐h pH studies are not considered to be good candidates for surgical fundoplication. Endoluminal gastroplication (ELGP) is a new endoscopic treatment for patients with GERD. The aim of this study was to evaluate the efficacy of ELGP in these patients. Methods: Patients with heartburn, regurgitation symptoms and a DeMeester score of less than 30 were studied. ELGP involved placement of two or three plications within 2 cm of the gastroesophageal junction. Clinical outcomes measured were heartburn symptom score (HSS), regurgitation frequency score (RFS) and medication use. Results: Twenty‐five patients (11 M, 14 F, mean age of 51 years) had a medication use of 11.5 doses of proton‐pump inhibitors per week prior to ELGP. Average lower esophageal sphincter pressure measured 15 ± 8 mmHg, and average DeMeester score was 18 ± 8. Nine patients had hiatal hernias and 11 had esophagitis. Twenty‐four patients were available for a mean follow‐up of 12 months. HSS significantly decreased from 48 to 17 (P < 0.01) and RFS was reduced from 1.8 to 0.7 (P < 0.01). Proton‐pump inhibitor use was 5.3 doses per week (P < 0.01) post‐ELGP; 12 patients (50%) were off medications, 3 (13%) had a 50% reduction in medication use, and in 9 (37%) there was no change. Complications were bleeding in one patient and aspiration pneumonia in another patient. Conclusions: Endoluminal gastroplication provides symptomatic relief for patients with classic GERD symptoms despite medical therapy and borderline 24‐h pH studies.

• Ambulatory pH monitoring
• endoscopy
• gastroesophageal reflux disease
• treatment