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Evaluating outcomes of endoscopic full-thickness plication for gastroesophageal reflux disease (GERD) with impedance monitoring

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Abstract

Background

Endoscopic full-thickness plication allows transmural suturing at the gastroesophageal junction to recreate the antireflux barrier. Multichannel intraluminal impedance monitoring (MII) can be used to detect nonacid or weakly acidic reflux, acidic swallows, and esophageal clearance time. This study used MII to evaluate the outcome of endoscopic full-thickness plication.

Methods

In this study, 12 subsequent patients requiring maintenance proton pump inhibitor therapy underwent endoscopic full-thickness plication for treatment of gastroesophageal reflux disease. With patients off medication, MII was performed before and 6-months after endoscopic full-thickness plication.

Results

The total median number of reflux episodes was significantly reduced from 105 to 64 (p = 0.016). The median number of acid reflux episodes decreased from 73 to 43 (p = 0.016). Nonacid reflux episodes decreased from 23 to 21 (p = 0.306). The median bolus clearance time was 12 s before treatment and 11 s at 6 months (p = 0.798). The median acid exposure time was reduced from 6.8% to 3.4% (p = 0.008), and the DeMeester scores were reduced from 19 to 12 (p = 0.008).

Conclusion

Endoscopic full-thickness plication significantly reduced total reflux episodes, acid reflux episodes, and total reflux exposure time. The DeMeester scores and total acid exposure time for the distal esophagus were significantly improved. No significant changes in nonacid reflux episodes and median bolus clearance time were encountered.

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Disclosures

Daniel von Renteln, Arthur Schmidt, and Bettina Riecken have no conflict of interest or financial ties to disclose. Karel Caca declares that he has served in the capacity as a member of the NDO Surgical, Inc. Medical Advisory Board from October 3, 2006 to October 3, 2007 and has received honoraria for speaking and training. No research funding or any other financial allocation was received regarding this study.

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Authors and Affiliations

  1. Department of Gastroenterology, Hepatology, and Oncology, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Germany

    Daniel von Renteln, Arthur Schmidt, Bettina Riecken & Karel Caca

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  1. Daniel von Renteln
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  2. Arthur Schmidt
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  4. Karel Caca
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Correspondence to Daniel von Renteln.

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von Renteln, D., Schmidt, A., Riecken, B. et al. Evaluating outcomes of endoscopic full-thickness plication for gastroesophageal reflux disease (GERD) with impedance monitoring. Surg Endosc 24, 1040–1048 (2010). https://doi.org/10.1007/s00464-009-0723-9

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  • DOI: https://doi.org/10.1007/s00464-009-0723-9

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