Endoscopic implantation of enteryx for the treatment of gastroesophageal reflux disease: technique, pre-clinical and clinical experience.
The implantation of Enteryx polymer in the LES is a fast, minimally invasive procedure with anticipated low procedural risks and limited costs. Preliminary clinical data after 6 months of follow-up show good results in more than 80% of the patients, with objective improvement of acid reflux time. Enteryx is effective in the management of GERD, as evidenced by the ability of GERD patients with a history of use of PPIs and other GERD medications to eliminate or significantly reduce use of these medications. Mechanisms of action of Enteryx implantation suggest a change in distensibility of the LES, allowing a greater competency of the cardia. LES pressure and length might be increased after polymer implantation, and further studies are needed to study the effect of Enteryx on transient relaxations of the LES, which is the prevalent mechanism of reflux in patients with mild GERD. Challenges with this procedure include refining technique to deliver adequate volume in each patient and determining if the ring-shaped implant is needed. In addition to acid reflux, another indication for use of this treatment might be biliary reflux in gastrectomized patients; preliminary data suggest that Enteryx may reduce symptoms and improve bile reflux (J. Devière, unpublished observations, 2002). Further studies are needed to definitively establish the safety of the procedure. This is a major point because gastroenterologists are not dealing with ill patients but primarily with individuals who have a good quality of life while taking PPIs. The other area to investigate is the efficacy of the treatment through a sham-controlled study. Finally, this endoscopic technique will have to be evaluated in terms of cost-effectiveness against medical and surgical therapies.
Louis
Hubert
H
Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070 Brussels, Belgium. hlouis@ulb.ac.be
Devière
Jacques
J
D000818:Animals; D001672:Biocompatible Materials / Q000627:therapeutic use*; D001704:Biopolymers / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004285:Dogs; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000628:therapy*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D011145:Polyvinyls / Q000627:therapeutic use*; D011183:Postoperative Complications; D019736:Prostheses and Implants; D013552:Swine; D016896:Treatment Outcome
D001672:Biocompatible Materials; D001704:Biopolymers; D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer