title: Transoral incisionless fundoplication for gastroesophageal reflux disease in an unselected patient population.
abstract: BACKGROUND
  EsophyX is an endolumenal approach to the treatment of gastroesophageal reflux disease (GERD). This report describes one of the earliest and largest North American experiences with this device.
  
  
  METHODS
  Prospective data were gathered on consecutive patients undergoing EsophyX fundoplication for a 1-year period between September 2007 and March 2009. During this time, the procedure evolved to the current technique. A P value less than 0.05 was considered significant.
  
  
  RESULTS
  The study enrolled 26 patients with a mean age of 45 years. The patients included 16 women (62%) with a mean body mass index (BMI) of 28 and an American Society Anesthesiology (ASA) classification of 2. These patients included 11 with associated small hiatal hernias, 3 with Barrett's esophagus, and 5 with esophageal dysmotility. The procedure time was 65 min (range, 29-137 min), and the length of hospital stay was 1 day (range, 0-6 days). The postoperative valve circumference was 217 degrees, and the valve length was 2.7 cm. Two complications of postoperative bleed occurred, requiring transfusion. The mean follow-up period was 10 months. Comparison of pre- and postoperative Anvari scores (34-17; P = 0.002) and Velanovich scores (22-10; P = 0.0007) showed significant decreases. Although 68% of the patients were still taking antireflux medications, 21% had reduced their dose by half. Three patients had persistent symptoms requiring Nissen fundoplication, and there was one late death unrelated to the procedure.
  
  
  CONCLUSIONS
  This study represents an initial single-institution experience with EsophyX. According to the findings, 53% of the patients had either discontinued their antireflux medication (32%) or had decreased their dose by half (21%). Both symptoms and health-related quality-of-life (HRQL) scores significantly improved after treatment. Further follow-up evaluation and objective testing are required.
authors.affiliation: Department of Surgery, Center for Minimally Invasive Surgery, The Ohio State University Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA. sebastian.demyttenaere@osumc.edu
authors.forename: Sebastian V
authors.initials: SV
authors.lastname: Demyttenaere
authors.forename: Simon
authors.initials: S
authors.lastname: Bergman
authors.forename: Thomas
authors.initials: T
authors.lastname: Pham
authors.forename: Joel
authors.initials: J
authors.lastname: Anderson
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dettorre
authors.forename: W Scott
authors.initials: WS
authors.lastname: Melvin
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Mikami
mesh_terms: D015897:Comorbidity; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000295:instrumentation / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome