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Endoluminal gastroplication in children with gastro-esophageal reflux disease

A study published in November's Gut finds that endoluminal gastroplication is an effective and safe procedure in children/adolescents with significant GERD refractory to, or dependent on, medical anti-GERD therapy.

News image

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Dr Thomson and colleagues from England undertook a study to describe pediatric experience of endoluminal gastroplication in children with gastro-esophageal reflux disease (GERD) refractory to, or dependent on, proton pump inhibitors.

The researchers also aimed to assess the associated complications and therapeutic effectiveness.

In total, the research group recruited 17 (5 male) consecutive children/adolescents with GERD either dependent for more than 12 months on proton pump inhibitors or non-responsive to medical treatment.

The endoscopists performed endoscopic gastroplication on participants using a flexible endoscopic sewing device (EndoCinch).

The investigators oversaw 3 plications being placed in gastric tissue below the lower esophageal sphincter.

The researchers compared drug dose requirement, pH measurements, daily symptom severity and frequency, and validated reflux (QOLRAD) and general gastrointestinal (GSRS) quality of life scores before and after endoscopic gastroplication.

All pH parameters improved and had returned to normal values in 14/16 patients post-treatment
Gut

The researchers found that all patients showed post-treatment improvement in symptom severity, frequency, and quality of life scores.

The doctors performed a repeat procedure on 3 patients with recurrent symptomatic GERD within 6 weeks and they did well subsequently.

The research group noted that at up to 33 months of follow up, 14/17 patients remained off all antireflux medications, and 14/17 had maintained their symptomatic improvement.

Dr Thompson concluded, "All pH parameters improved and had returned to normal values in 14/16 patients post-treatment and in 6/9 after one year of follow-up".

"In particular the reflux index had decreased from a median of 16.6% to 2.5% 6 weeks and 4.3% 12 months post-procedure".

The research group added, "The only complication observed was gastric bleeding in one patient due to previously undiagnosed coagulopathy, which spontaneously resolved."

The researchers concluded, "Endoluminal gastroplication is an effective and safe procedure in children/adolescents with significant GERD refractory to, or dependent on, medical anti-GERD therapy."

Gut; 2004: 53:1745-1750
15 November 2004

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