Endoscopic suturing for treatment of GERD

Abstract

Swain and Mills first described the concept and technology of endoscopic suturing or sewing in 1986. 1 Swain CP Mills TN. An endoscopic sewing machine. Gastrointest Endosc. 1986; 32: 36-38 Abstract Full Text PDF PubMed Scopus (91) Google Scholar Subsequent animal and cadaver studies documented that endoscopic placement of sutures in the cardia of the stomach was feasible. Early reports demonstrated that the technique increased the overall length of the lower esophageal sphincter (LES) as determined manometrically, its intra-abdominal length, and/or its pressure depending on the configuration of the suture placement. 2 Swain CP Kadirkamanathan SS Gong F Lai KC Ratani RS Brown GJ et al. Knot tying at flexible endoscopy. Gastrointest Endosc. 1994; 40: 722-729 PubMed Google Scholar , 3 Kadirkamanathan SS Evans DF Gong F Yazaki E Scott M Swain CP. Antireflux operations at flexible endoscopy using endoluminal stitching techniques: an experimental study. Gastrointest Endosc. 1996; 44: 133-143 Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar , 4 Martinez-Serna T Davis RE Mason R Perdikis G Filipi CJ Lehman G et al. Endoscopic valvuloplasty for GERD. Gastrointest Endosc. 2000; 52: 663-670 Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar Initial use of a similar device in humans with GERD was first described in 2001. 5 Filipi CJ Lehman GA Rothstein RI Raijman I Steigman GV Waring JP et al. Transoral, flexible endoscopic suturing for treatment of GERD: a multicenter trial. Gastrointest Endosc. 2001; 53: 416-422 Abstract Full Text Full Text PDF PubMed Scopus (281) Google Scholar Two forms of endoscopic suturing devices are currently available (EndoCinch, Bard, Inc., Bellerica, Mass.; Sew-Right Device, Wilson-Cook Medical, Inc., Winston Salem, N.C.). EndoCinch is the only Food and Drug Administration (FDA)-approved device for use as therapy in patients with GERD. GERD affects 20% or more of adult Americans and can be effectively treated in most cases either pharmacologically or surgically. 6 Dent J Brun J Fendrick AM Fennerty MB Janssens J Kahrilas PJ et al. An evidence-based appraisal of reflux-disease management. The Genval Workshop Report. Gut. 1999; 44: 51-516 Google Scholar H2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) can control symptoms of reflux in 85% to 95% of patients when escalating doses are used. Similarly, antireflux surgery (Laparoscopic Nissen Fundoplication or LNF) performed by an experienced surgeon will alleviate reflux-related symptoms in 80% to 90% of patients. 6 Dent J Brun J Fendrick AM Fennerty MB Janssens J Kahrilas PJ et al. An evidence-based appraisal of reflux-disease management. The Genval Workshop Report. Gut. 1999; 44: 51-516 Google Scholar , 7 Spechler SJ Lee A Ahnen D Goyal RK Hirano I Ramirez F et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow up of a randomized controlled trial. JAMA. 2001; 285: 2376-2378 Crossref PubMed Scopus (832) Google Scholar Thus, few patients with GERD who have symptoms are truly refractory to pharmacologic and/or surgical approaches to GERD therapy.