Therapeutic effect of endoscopic anterior fundoplication by MUSE™ in thirteen patients with gastroesophageal reflux disease

Abstract

Objective To evaluate the efficacy and safety of endoscopic anterior fundoplication by the MUSE™ endoscopic stapling device in gastroesophageal reflux disease (GERD). Methods From March to November 2017, in the Department of Gastroenterology of Chinese PLA General Hospital in Beijing, The First People′s Hospital Affiliated to Shanghai Jiao Tong University and Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, thirteen GERD patients who underwent the endoscopic anterior fundoplication by the MUSE™ system were enrolled. The GERD health related quality of life questionnaire (GERD-HRQL) score, satisfaction of symptomatic control, questionnaire for gastroesophageal reflux disease (GERD-Q) score, the degree of esophagitis, condition of gastroesophageal flap valve, medicine administration and side effects were compared before and after the operation. Paired t test and Wilcoxon rank sum test were performed for statistical analysis. Results The total GERD-HRQL score decreased from 23 points (14 to 36 points) before operation when proton pump inhibitor (PPI) was stopped for seven days to 3 points (0 to 21 points) at three months after operation and 1 point (0 to 18 points) at six months after operation; and the differences were statistically significant (Z=-3.111 and -3.183, both P 0.05). The number of patients without esophagitis increased from three before treatment to eight after treatment. Additionally, the number of patients whose gastroesophageal flap valve was less than grade Ⅱ increased from three before operation to 11 at six months after operation. The patients were followed up for six months, among 13 patients, 10 patients were completely deprived of PPI, one patient was reduced over 50%, and two patients were treated with less than 50% reduction. All 13 patients had mild tolerable abdominal pain and sore throat within 48 hours after operation. No other adverse reactions were observed. Conclusion The endoscopic anterior fundoplication by the MUSE™ is a safe and effective treatment for GERD. Key words: Gastroesophageal reflux; Fundoplication; Proton pump inhibitors; Medigus ultrasonic surgical endostapler