title: Subjective and objective data on esophageal manometry and impedance pH monitoring 1 year after endoscopic full-thickness plication for the treatment of GERD by using multiple plication implants.
abstract: BACKGROUND
  Subjective and especially objective data after endoluminal full-thickness gastroplication are scarce.
  
  
  OBJECTIVE
  To evaluate symptoms and reflux activity 12 months after gastroplication by using multichannel intraluminal impedance monitoring.
  
  
  METHODS
  Open-label, prospective, single-center study.
  
  
  METHODS
  Tertiary referral hospital in Zell am See, Austria.
  
  
  METHODS
  Subjects without hiatal hernias with documented GERD and persistent or recurrent symptoms despite treatment with a proton pump inhibitor.
  
  
  METHODS
  A total of 36 patients underwent endoscopic full-thickness gastroplication with 1 or more Plicator implants.
  
  
  METHODS
  Mean Gastrointestinal Quality of Life Index and reflux-specific symptom scores significantly improved on follow-up (P < .01). Atypical reflux, gas/bloating, and bowel dysfunction-specific symptom scores as well as belching and dysphagia scores improved. Twenty-two patients returned for esophageal manometry and multichannel intraluminal impedance testing 1 year after surgery. DeMeester scores decreased from 20 to 10 (P < .029). The median numbers of total, acid, proximal, upright, and recumbent reflux episodes were all significantly reduced (P < .05). Manometric data were virtually unchanged. The percentage of patients taking proton pump inhibitors on daily basis after the procedure was 11.5%. There was only 1 postprocedure incident (bleeding) that required intervention. Three of 36 patients (8.3%) were considered treatment failures because of persistent symptoms and were assigned to undergo laparoscopic fundoplication.
  
  
  CONCLUSIONS
  No randomized comparison with a sham procedure or laparoscopic fundoplication; follow-up interval.
  
  
  CONCLUSIONS
  Endoscopic plication is safe and improves objective and subjective parameters at 1-year follow-up, without side effects seen after laparoscopic fundoplication. Further studies on the clinical merit of this procedure in specific patient populations are warranted.
authors.affiliation: Department of General Surgery, General Hospital Zell am See, Zell am See, Austria.
authors.forename: Oliver O
authors.initials: OO
authors.lastname: Koch
authors.forename: Adolf
authors.initials: A
authors.lastname: Kaindlstorfer
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Antoniou
authors.forename: Georg
authors.initials: G
authors.lastname: Spaun
authors.forename: Rudolph
authors.initials: R
authors.lastname: Pointner
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanstrom
mesh_terms: D017097:Electric Impedance; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus / Q000502:physiology*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D019736:Prostheses and Implants; D016896:Treatment Outcome