Long-term outcome of endoluminal gastroplication in the treatment of gastro-oesophageal reflux disease: Effect of a second procedure

Abstract

Objective. Endoluminal gastroplication has been used with limited success for the treatment of gastro-oesophageal reflux disease (GORD). This method was used in 119 patients with GORD, and the results from short-term and long-term follow-up of symptoms and the use of acid suppression medication are reported. The purpose of this study was also to report on the effect of a second procedure on selected patients. Material and methods. The Bard EndoCinch® endosuturing system was used for all procedures. Data were recorded at 3 and 12 months, and symptoms and medication use were registered by means of a telephone survey after an average of 41 months (range 27–55 months). A second procedure was carried out in 20 of the initial patients, and mean follow-up time was 39 months (range 15–51 months). Results. There were very few complications of the procedure. Heartburn severity score was reduced from an initial 21.4 to 12.4 (p <0.01) and 13.4 (p<0.01) at 3 and 12 months, respectively, corresponding to a reduction in the use of acid suppression from 8.7 doses per week (DD/w) to 4.0 (p<0.01) and 5.6 DD/w (p<0.01). At long-term follow-up there was a return towards baseline values for acid suppression use (6.4 DD/w, p=0.06), whereas the heartburn severity score remained low (8.5, p<0.01). Loss of sutures was significant, from an average of 2.51 applied sutures to 1.87 (p<0.01) and 1.81 (p<0.01) remaining sutures at 3 and 12 months, respectively. After the second procedure, the heartburn severity score fell from an initial 22.5 to 12.7 (p<0.01) after 3 months and remained low at long-term follow-up (6.6, p<0.01). The corresponding data for acid suppression use were 11.7, 3.6 (p<0.01) and 5.2 (p<0.01) DD/w. Number of sutures increased from an average of 2.15 sutures placed initially, with 2.65 sutures added at the second procedure, to an average of 2.80 remaining sutures (p<0.01) at 3 months. Conclusions. Endoluminal gastroplication has a significant, yet transient effect on symptom score and the use of acid suppressants in GORD patients. A selection of patients for a subsequent procedure may be of value.