title: Endoluminal gastroplication in children with significant gastro-oesophageal reflux disease.
abstract: OBJECTIVE
  To describe paediatric experience, and to assess complications and therapeutic effectiveness of the use of endoluminal gastroplication in children with gastro-oesophageal reflux disease (GORD) refractory to, or dependent on, proton pump inhibitors.
  
  
  METHODS
  Seventeen (five male) consecutive children/adolescents (median (range) age 12.4 (6.1-15.9) years, median (range) weight 46.0 (16.5-87.5) kg) with GORD either dependent for more than 12 months on proton pump inhibitors or non-responsive to medical treatment underwent endoscopic gastroplication using a flexible endoscopic sewing device (EndoCinch). Three plications were placed in gastric tissue below the lower oesophageal sphincter. Drug dose requirement, pH measurements, daily symptom severity and frequency, and validated reflux (QOLRAD) and general gastrointestinal (GSRS) quality of life scores were compared before and after endoscopic gastroplication.
  
  
  RESULTS
  All patients showed post-treatment improvement in symptom severity, frequency, and quality of life scores (p<0.0001). Three patients with recurrent symptomatic GORD had a repeat procedure within six weeks and did well subsequently. At up to 33 months of follow up (median 23), 14/17 patients remained off all antireflux medications, and 14/17 had maintained their symptomatic improvement. 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% (0.9-67%) to 2.5% (0.7-15.7%) (p<0.0001) six weeks and 4.3% (2.2-20.6) (p<0.02) 12 months post-procedure. The only complication observed was gastric bleeding in one patient due to previously undiagnosed coagulopathy, which spontaneously resolved.
  
  
  CONCLUSIONS
  Endoluminal gastroplication is an effective and safe procedure in children/adolescents with significant GORD refractory to, or dependent on, medical anti-GORD therapy.
authors.affiliation: Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK. mike.thomson@sch.nhs.uk
authors.forename: M
authors.initials: M
authors.lastname: Thomson
authors.forename: A
authors.initials: A
authors.lastname: Fritscher-Ravens
authors.forename: S
authors.initials: S
authors.lastname: Hall
authors.forename: N
authors.initials: N
authors.lastname: Afzal
authors.forename: P
authors.initials: P
authors.lastname: Ashwood
authors.forename: C P
authors.initials: CP
authors.lastname: Swain
mesh_terms: D000293:Adolescent; D000863:Antacids / Q000627:therapeutic use; D002648:Child; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000534:rehabilitation / Q000601:surgery*; D015391:Gastroplasty / Q000379:methods; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D054328:Proton Pump Inhibitors; D011788:Quality of Life; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000863:Antacids; D054328:Proton Pump Inhibitors