Transoral, flexible endoscopic suturing for treatment of GERD: A multicenter trial

Charles J. Filipi, Glen A. Lehman, Richard I. Rothstein, Isaac Raijman, Gregory V. Stiegmann, J. Patrick Waring, John G. Hunter, Christopher J. Gostout, Steven A. Edmundowicz, Donal P. Dunne, Patrice A. Watson, Douglas A. Cornet

Research output: Contribution to journalArticlepeer-review

276 Scopus citations

Abstract

A totally transoral outpatient procedure for the treatment of GERD would be appealing. A multicenter trial was initiated that included 64 patients with GERD treated with an endoscopic suturing device. Inclusion criteria were 3 or more heartburn episodes per week while not taking medication, dependency on antisecretory medicine, and documented acid reflux by pH monitoring. Exclusion criteria were dysphagia, grade 3 or 4 esophagitis, obesity, and hiatus hernia greater than 2 cm in length. Patients underwent manometry, endoscopy, 24-hour pH monitoring, and symptom severity scoring before and after the procedure. Patients were randomized to a linear or circumferential plication configuration. Adverse procedural events were recorded. Mean 6-month symptom score changes demonstrated procedural efficacy. Heartburn severity and frequency as well as regurgitation all improved (p > 0.0001 for each). Twenty-four-hour pH monitoring showed improvement in number of episodes below pH of 4 at 3 and 6 months (p < 0.0007 and 0.0002) and percentage of total time the pH was less than 4 at 6 months (p < 0.011). Plication configuration did not affect symptoms or pH monitoring results. One patient had a self-contained suture perforation that was successfully treated with antibiotics. Endoscopic gastroplasty is safe. It is associated with reduced symptoms and medication use at 6 month follow-up in patients with uncomplicated GERD.

Original languageEnglish (US)
Pages (from-to)416-422
Number of pages7
JournalGastrointestinal endoscopy
Volume53
Issue number4
DOIs
StatePublished - Apr 2001

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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