title: Reflux parameters as modified by EsophyX or laparoscopic fundoplication in refractory GERD.
abstract: BACKGROUND
  EsophyX is a novel transoral incisionless fundoplication device developed to mimic surgical fundoplication. EsophyX fundoplication improves acid reflux parameters in proton pump inhibitor (PPI)-responsive GERD patients but its efficacy in refractory GERD has been scarcely studied.
  
  
  OBJECTIVE
  To assess reflux parameters before and after EsophyX or laparoscopic fundoplication and their relationship with symptoms in refractory GERD.
  
  
  METHODS
  In an open-label study, we enrolled prospectively patients with heartburn/regurgitation persisting despite high-dose PPI therapy. Impedance-pH monitoring was performed on PPI therapy before intervention and off PPI therapy 3 months after intervention.
  
  
  RESULTS
  Ten patients chose to undergo EsophyX (EndoGastric Solutions, Redmond, WA, USA) fundoplication while ten chose laparoscopic fundoplication, and the baseline characteristics were comparable. Distal and proximal refluxes were significantly reduced post-operatively in the surgical but not in the endoscopic group and the median values were significantly lower in the former than in the latter. The oesophageal acid exposure time was normal in 50% of cases after EsophyX and in 100% of cases after surgery (P=0.033); the number of distal refluxes was normal in 20% and 90% of cases (P=0.005) and the number of proximal refluxes was normal in 40% and 100% of cases (P=0.011), respectively. A positive persisting symptom-reflux association was found post-operatively in 6/10 patients in the EsophyX group and in 0/10 patients in the surgical group (P=0.011).
  
  
  CONCLUSIONS
  In patients with refractory GERD, EsophyX fundoplication is significantly less effective than laparoscopic fundoplication in improving reflux parameters and accordingly, in inducing symptom remission.
authors.affiliation: Fisiopatologia Digestiva, Nuovo Ospedale S. Agostino, Modena, Italy. m.frazzoni@ausl.mo.it
authors.forename: M
authors.initials: M
authors.lastname: Frazzoni
authors.forename: R
authors.initials: R
authors.lastname: Conigliaro
authors.forename: R
authors.initials: R
authors.lastname: Manta
authors.forename: G
authors.initials: G
authors.lastname: Melotti
mesh_terms: D050782:Esophageal pH Monitoring; D005500:Follow-Up Studies; D018662:Fundoplication / Q000295:instrumentation / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006356:Heartburn / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D057045:Laryngopharyngeal Reflux / Q000601:surgery*; D008365:Manometry; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors