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 |
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.”