Endoscopic full-thickness plication for the treatment of GERD: long-term multicenter results.
BACKGROUND
The purpose of the present study was to assess the long-term safety and durability of effect for endoscopic full-thickness plication for the treatment of symptomatic gastroesophageal reflux disease (GERD). The Plicator (NDO Surgical, Inc., Mansfield, MA) used delivers a transmural suture through the gastric cardia to restructure the antireflux barrier. Published reports have shown the Plicator procedure to be effective in reducing GERD symptoms and medication use at 1 year post-plication.


METHODS
Twenty-nine patients with chronic heartburn requiring maintenance daily anti-secretory therapy were treated at five sites. Patients received a single full-thickness plication in the gastric cardia 1cm below the gastroesophageal junction (GE) junction. Re-treatments were not permitted. Patients were evaluated at baseline for GERD symptoms and medication use. Intermediate (12 month) and long-term subject follow-up (median follow-up: 36.4 months; range, 31.2-43.9 months) were completed to evaluate procedure safety and durability of effect.


RESULTS
Twenty-nine patients completed the 12-month and 36-month follow-up. All procedure-related adverse events occurred acutely, and no new events were observed during extended follow-up. At 36-months post-procedure, 57% (16/28) of baseline proton pump inhibitor (PPI)-dependent patients remained off daily PPI therapy. Treatment effect remained stable from 12- to 36-months, with 21/29 patients off daily PPI at 12 months compared to 17/29 patients at 36-months. Median GERD- Health Related Quality of Life (HRQL) scores remained significantly improved at 36 months versus baseline off-meds scores (8 versus 19, p < 0.001). In addition, the proportion of patients achieving > or = 50% improvement in GERD-HRQL score was consistent from 12 months (59%) to 36 months (55%).


CONCLUSIONS
Endoscopic full-thickness plication can reduce GERD symptoms and medication use for at least 3-years post-procedure. Treatment effect is stable from 1 to 3 years, and there are no long-term procedural adverse effects.
Pleskow
D
D
Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
Rothstein
R
R
Kozarek
R
R
Haber
G
G
Gostout
C
C
Lembo
A
A
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000863:Antacids / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005753:Gastric Mucosa / Q000293:injuries; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000601:surgery*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000209:etiology; D054328:Proton Pump Inhibitors; D011788:Quality of Life; D016896:Treatment Outcome
D000863:Antacids; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors