Case-control comparison of endoscopic gastroplication with laparoscopic fundoplication in the management of gastroesophageal reflux disease: early symptomatic outcomes.
Endoscopic gastroplication is a new technique in the management of gastroesophageal reflux disease. No comparisons of this technique with laparoscopic fundoplication have been done. Twenty-seven patients with symptoms of reflux disease were evaluated with upper endoscopy, esophageal manometry, and 24-hour esophageal pH monitoring, as well as a symptom severity questionnaire. Patients then underwent endoscopic gastroplication with use of the Bard Interventional Endoscopic Suturing System. Patients completed the symptom severity questionnaire 6 weeks after the procedure. These 27 patients were matched for age, gender, and pre-procedure symptom score with patients in a prospectively gathered database of laparoscopic antireflux operations. Twenty-one patients (78%) in the endoscopic gastroplication group were satisfied with their symptomatic outcome, 2 (7%) were neutral, and 4 (15%) were dissatisfied. In comparison, there were 26 satisfied patients (96%) in the laparoscopic group ( < 0.01). Median symptom scores improved similarly in both groups, with no statistically significant difference. The patients who were dissatisfied had a mean improvement in symptom score of 10, compared with 27 for the satisfied patients ( < 0.01). Endoscopic gastroplication is a viable alternative to laparoscopic fundoplication in selected patients. Nevertheless, approximately one quarter of patients will have no improvement, which is much more than those undergoing laparoscopic fundoplication.
Velanovich
Vic
V
Division of General Surgery, K-8, Henry Ford Hospital, Detroit, MI 48202, USA. vvelanol@hfhs.org
Ben-Menachem
Tamir
T
Goel
Sachin
S
D000328:Adult; D016022:Case-Control Studies; D016145:Endoscopy, Digestive System; D005260:Female; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome