Medium-term outcome of endoluminal gastroplication with the EndoCinch device in children.
OBJECTIVE
Endoluminal gastroplication (EG) is emerging as a minimally invasive procedure for the treatment of gastroesophageal reflux disease (GERD). The aim of this study is to evaluate the medium-term outcomes after EG in a pediatric patient population.


METHODS
Seventeen children with a median age of 12.4 years (range 6.1-15.9 years) with GERD underwent EG using a flexible endoscopic sewing device (EndoCinch) over a period of 3 years. Three plications were placed in the gastric tissue below the lower esophageal sphincter. Drug dose requirement, pH measurements, symptom severity and frequency, and validated Quality of Life in Reflux and Dyspepsia (QOLRAD) scores were compared before EG and 1 and 3 years after EG. Statistical analysis was performed using a Wilcoxon rank-sum test and P < 0.05 was the threshold for significance.


RESULTS
All patients showed an immediate posttreatment improvement in symptom severity, symptom frequency, and quality of life scores. Completed 1- and 3-year data were obtained from 16 patients. Four cases (25%) required a repeat procedure as a result of recurrence of symptoms after 2 to 24 months. Fourteen patients (88%) at 1 year and 9 patients (56%) at 3 years remained without a need for any antireflux medication. A sustained improvement in heartburn (P = 0.004), regurgitation (P = 0.017), and vomiting (P = 0.018) was seen at 3 years. The total QOLRAD score (maximum of 175) improved from a median of 87 (range 69-142) to 156 (range 111-175) at 1 year (P < 0.0001) and 153.5 (range 55-174) at 3 years (P = 0.002).


CONCLUSIONS
EG is an effective and safe procedure in children. It is a viable option for the treatment of GERD refractory to or dependent on antireflux medications.
Thomson
Mike
M
Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, UK. mike.thomson@sch.nhs.uk
Antao
Brice
B
Hall
Sharon
S
Afzal
Nadeem
N
Hurlstone
Paul
P
Swain
C Paul
CP
Fritscher-Ravens
Annette
A
D000293:Adolescent; D002648:Child; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D011183:Postoperative Complications; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors