title: Long-term benefit of transoral incisionless fundoplication using the esophyx device for the management of gastroesophageal reflux disease responsive to medical therapy.
abstract: Transoral incisionless fundoplication (TIF) using the EsophyX device has been shown to be effective and safe in patients with Gastroesophageal reflux disease (GERD); however, the subset of patients that would mostly benefit from this technique remains unknown. The aim of this study was to evaluate the long-term efficacy and safety of the TIF procedure in patients with a history of esophagitis or proven chronic GERD who have achieved symptom control with the administration of proton pump inhibitors (PPIs) but did not wish to continue receiving medications for life. Forty-five patients with typical GERD symptoms (heartburn, regurgitation, chest pain) and a history of esophagitis grade A and B or proven GERD by esophageal pH monitoring underwent TIF using Esophyx. Patients with eosphagitis C and D or those with large hiatal hernias (>2 cm in length) were excluded. The primary clinical effectiveness measure was GERD symptom elimination at follow up based on normalization of the GERD health related quality of life (GERD-HRQL) questionnaire. After a median follow up period of 59 months (36-75) the median GERD-HRQL scores improved significantly from 27 (2-45) at baseline to 4 (0-26) (P < 0.001) in the 44 patients completing the study. Heartburn was eliminated in 12 out of the 21 patients included (57.1%), regurgitation was eliminated in 15 out of the 17 patients included (88.2%) and finally chest pain was eliminated in 5 patients out of the six patients included (83.3%). Overall, 32 patients out of the 44 patients (72.7%) that completed the study follow up reported elimination of their main symptom, without the need for PPI administration (none PPI usage). Furthermore, six more patients (13.6%), five with heartburn, and one with regurgitation reported half PPI dose taken for <50% of the preceding follow up period (occasional PPI usage), while six more patients (four with heartburn, one with regurgitation, and one with chest pain) reported full or half PPI dose taken for more than 50% of the preceding follow up period (daily PPI usage). Creation of an esophagogastric fundoplication using the EsophyX device abolished reflux symptoms in 72.7% of PPI-responsive GERD patients at a median 59 month follow-up.
authors.affiliation: Gastroenterology Department, Athens Naval Hospital, Athens, Greece.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Stefanidis
authors.affiliation: Gastroenterology Department, Evangelismos Hospital, Athens, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Viazis
authors.affiliation: Gastroenterology Department, Athens Naval Hospital, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kotsikoros
authors.affiliation: Gastroenterology Department, Athens Naval Hospital, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsoukalas
authors.affiliation: Gastroenterology Department, Athens Naval Hospital, Athens, Greece.
authors.forename: Eythymia
authors.initials: E
authors.lastname: Lala
authors.affiliation: Anesthesiology Department, Athens Naval Hospital, Athens, Greece.
authors.forename: Loukas
authors.initials: L
authors.lastname: Theocharis
authors.affiliation: Anesthesiology Department, Athens Naval Hospital, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fassaris
authors.affiliation: 2nd Academic Department of Internal Medicine, Hippokration Hospital of Athens, Athens, Greece.
authors.forename: Spilios
authors.initials: S
authors.lastname: Manolakopoulos
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004941:Esophagitis / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000295:instrumentation* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation* / Q000379:methods; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013995:Time; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors
keywords: fundoplication; gastroesophageal reflux; proton pump inhibitors; transoral incisionless