Long-term outcomes of patients with refractory gastroesophageal reflux disease following a minimally invasive endoscopic procedure: a prospective observational study.

Wei-Tao Liang,Ji-Min Wu,Jian-Jun Liu,Zhong-Gao Wang,Zhi-Wei Hu,Yue Yang,Feng Wang,Guang-Chang Zhu,Chao Zhang

doi:10.1186/1471-230x-14-178

Abstract

BackgroundGastroesophageal reflux disease (GERD) is the most common digestive disease, affecting one third of the world’s population. The minimally invasive endoscopic Stretta procedure is being increasingly used as an alternative strategy to manage refractory GERD. However, long-term benefits of this procedure have to be further evaluated in clinical settings. This prospective observational study was therefore conducted to evaluate the outcome of patients with refractory GERD 5 years after the Stretta procedure.MethodsA total of 152 patients with refractory GERD underwent the Stretta procedure in our department between April 2007 and September 2008. They were followed up for 5 years, during which the primary outcome measures including symptom scores of heartburn, regurgitation, chest pain, cough and asthma and the secondary outcome measures including proton pump inhibitor (PPI) use and patients’ satisfaction were analysed at 6, 12, 24, 36, 48 and 60 months respectively.ResultsOf the 152 patients, 138 completed the designated 5-year follow-up and were included in the final analysis. At the end of the 5-year follow-up, the symptom scores of heartburn (2.47 ± 1.22 vs. 5.86 ± 1.52), regurgitation (2.23 ± 1.30 vs. 5.56 ± 1.65), chest pain (2.31 ± 0.76 vs. 4.79 ± 1.59), cough (3.14 ± 1.43 vs. 6.62 ± 1.73) and asthma (3.26 ± 1.53 vs. 6.83 ± 1.46) were all significantly decreased as compared with the corresponding values before the procedure (P < 0.001). After the Stretta procedure, 59 (42.8%) patients achieved complete PPI therapy independence and 104 (75.4%) patients were completely or partially satisfied with the GERD symptom control. Moreover, no severe complications were observed except for complaint of abdominal distention in 12 (8.7%) patients after the Stretta procedure.ConclusionThe Stretta procedure may achieve an effective and satisfactory long-term symptom control and considerably reduce the reliance on medication without significant adverse effects in adult patients with refractory GERD, thereby having profound clinical implications.

Highlights

Gastroesophageal reflux disease (GERD) is the most common digestive disease, affecting one third of the world’s population
By the end of the 5-year follow-up, the total heartburn score was significantly lower as compared with the score before the Stretta procedure (P < 0.001) and the effect of the procedure was of no significant difference in patients with and without extraesophageal symptoms (P > 0.05, Figure 1)
We found that the Stretta procedure was effective to control heartburn and regurgitation very in GERD patients with and without extraesophageal symptoms (Figures 1 and 2) but was less effective in eliminating pump inhibitor (PPI) usage in patients with extraesophageal symptoms than in patients without extraesophageal symptoms (Figure 6)

Summary

Introduction

Gastroesophageal reflux disease (GERD) is the most common digestive disease, affecting one third of the world’s population. The minimally invasive endoscopic Stretta procedure is being increasingly used as an alternative strategy to manage refractory GERD. Long-term benefits of this procedure have to be further evaluated in clinical settings This prospective observational study was conducted to evaluate the outcome of patients with refractory GERD 5 years after the Stretta procedure. Affecting one third of the world’s population, GERD inflicts significant direct and indirect costs and loss of productivity [2]. Up to 40% of GERD patients are refractory to PPIs [7,8] These intrinsic drawbacks of PPI therapy necessitate the development of alternative strategies to manage GERD

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Discussion

Conclusion