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

• Published in: Scandinavian journal of gastroenterology Vol. 43; no. 1; p. 5
• Main Authors: Paulssen, Eyvind J, Lindsetmo, Rolv-Ole
• Format: Journal Article
• Language: English
• Published: England 01.01.2008
• Subjects: Female; Follow-Up Studies; Gastroesophageal Reflux - surgery; Heartburn - etiology; Humans; Male; Middle Aged; Reoperation; Stomach - surgery; Sutures; Treatment Outcome
• ISSN: 0036-5521
• DOI: 10.1080/00365520701514560

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 followup 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. 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). 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. 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.