Endoscopic Full-thickness Plication For Treatment Research Articles

Evaluating outcomes of endoscopic full-thickness plication for gastroesophageal reflux disease (GERD) with impedance monitoring

Endoscopic full-thickness plication allows transmural suturing at the gastroesophageal junction to recreate the antireflux barrier. Multichannel intraluminal impedance monitoring (MII) can be used to detect nonacid or weakly acidic reflux, acidic swallows, and esophageal clearance time. This study used MII to evaluate the outcome of endoscopic full-thickness plication. In this study, 12 subsequent patients requiring maintenance proton pump inhibitor therapy underwent endoscopic full-thickness plication for treatment of gastroesophageal reflux disease. With patients off medication, MII was performed before and 6-months after endoscopic full-thickness plication. The total median number of reflux episodes was significantly reduced from 105 to 64 (p = 0.016). The median number of acid reflux episodes decreased from 73 to 43 (p = 0.016). Nonacid reflux episodes decreased from 23 to 21 (p = 0.306). The median bolus clearance time was 12 s before treatment and 11 s at 6 months (p = 0.798). The median acid exposure time was reduced from 6.8% to 3.4% (p = 0.008), and the DeMeester scores were reduced from 19 to 12 (p = 0.008). Endoscopic full-thickness plication significantly reduced total reflux episodes, acid reflux episodes, and total reflux exposure time. The DeMeester scores and total acid exposure time for the distal esophagus were significantly improved. No significant changes in nonacid reflux episodes and median bolus clearance time were encountered.

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

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.