Effects of Endoscopic Full-Thickness Plication On GERD Measured By Multichannel Intraluminal Impedance Monitoring

Abstract

Background: Endoscopic full-thickness plication (Plicator®) has been shown to be effective at controlling reflux symptoms and esophageal acid exposure in a recently published prospective randomized, sham-controlled trial. By means of multichannel intraluminal impedance monitoring (MII), detection of nonacid or weakly acidic reflux events, aerophagia, and differentiation of true reflux events from non-reflux events is possible. In this study, the effects of endoscopic full-thickness plication measured by MII was analysed. Patients and Methods: 11 patients requiring maintenance proton pump inhibitor therapy underwent endoscopic full-thickness plication for treatment of gastro-esophageal reflux disease (GERD). MII was performed off-medication before and 6 month after endoscopic full-thickness plication in all patients. The effect of endoscopic full-thickness plication on acid, nonacid and weakly acidic reflux events were assessed. Results: 11 patients underwent endoscopic full-thickness plication using two or three serially placed Plicator implants. The mean number of total reflux and acid reflux episodes significantly decreased after the procedure (123 vs. 63, p < 0.02, 75 vs. 37, p < 0.02. The mean acid exposure time significantly decreased after treatment (124 min. vs. 41 min., p < 0.01). Total reflux exposure time and the mean DeMeester score significantly decreased after treatment (9.2% vs. 2.9%, p < 0.01, 27 vs. 9, p < 0.01).). The mean number of non-acid reflux episodes were not significantly decreased after the procedure (48 vs. 26, p = 0.306). The median bolus clearance time was not significantly changed (12 sec. vs. 11 sec. p = 0.798). Conclusions: Evaluation of endoscopic full-thickness plication efficacy by MII showed significant reduction in the mean number of total reflux episodes, acid reflux episodes and total reflux exposure time. Furthermore, the mean DeMeester score and the mean total acid exposure time in the distal esophagus were significantly decreased. No significant decrease was measured for non-acid reflux episodes or the median bolus clearance time.