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 17 November 2017

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News

Long-term failure of endoscopic suturing in treating GERD

The short-term beneficial effects of suturing were not maintained at the 1-year follow-up and endoscopic gastroplication cannot therefore be recommended for routine clinical use, finds the most recent issue of Endoscopy.

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Several endoscopic antireflux therapies have been marketed, but long-term data on their objective and clinical efficacy are sparse.

Dr Abou-Rebyeh and colleagues from Germany considered the technical, clinical, and functional success rates for the first of these treatments to be developed; endoscopic gastroplication by analyzing prospective 1-year follow-up results.

The researchers carried out a total of 43 endoscopic gastroplication procedures in 38 patients with gastroesophageal reflux disease.

The team constructed 2 or 3 EndoCinch gastroplications at the level of the gastric cardia in each patient; 5 patients were treated 2 times within 6 - 12 months.

After 1 year none of the 38 patients had all of the initially placed gastroplications in situ
Endoscopy

Each endoscopic suture joined 2 gastric folds to each other as a double fold, known as a ”gastroplication”, in order to narrow the esophagogastric junction.

The investigative team compared postprocedure data after 2 months and after 1 year with preoperative data, focusing on symptoms, medication requirements, endoscopic findings and pH-metry results.

The researchers showed that at 2 months, 72 % of the sutures were present and that there was a reduction in the percentage of time when the esophageal pH was < 4 from 15 % to 9 %.

1 year after EGP none of the 38 patients had all of the initially placed gastroplications in situ and 90 % of gastroplications were lost, which the researchers considered to indicate failure.

The team noted that the percentage of patients who did not require proton pump inhibitor medication decreased from 52 % at 2 months to only 20 % at 1 year.

In addition, the research team found that even more patients had evidence of reflux esophagitis at 1 year (56 %) than had initially demonstrated signs of this (41 %).

Dr Abou-Rebyeh concluded, “Endoscopic gastroplication has some short-term beneficial effects on clinical symptoms and pH-metry.”

“However, mainly due to the loss of the endoscopically placed sutures, these effects were not maintained at the 1-year follow-up and endoscopic gastroplication cannot therefore be recommended for routine clinical use.”

“Better endoscopic methods need to be developed, and they should be adequately tested before being marketed.”

Endoscopy 2005; 37: 213-216
28 February 2005

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