Clinical utility of endoluminal gasrtroplication in gastroesophageal reflux disease.
Yang Yunsheng, Linghua Enqiang, Sun Gang, Wang Xiangdong, Meng Jiangyun, Guo Rongbin, Wang Zhiqiang, Cheng Liufang and Wang Hongzhi
Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853,China.
Abstract Objective The transoral endoluminal gasrtroplication (ELGP) is a new endoscopic therapy in gastroesophageal reflux disease (GERD) and appealing. We studied the treatment for its procedures, safety, indications, contraindications and the primary efficacy. Methods 26 patients with GERD were performed by routin endoscopic examination followed ELGP, including 2 patients with resection of cardiac orifice. These patients suffered from 3 or more heartburn or regurgitation episodes per week while taking no medicine, and the acid reflux was verified by 24-hour pH monitoring. The ELGP was performed with a linear pattern in 8 patients, circumferential in 14 cases and the combination of both patterns in 4 patients. The suturing device was available of the B** Suturing SystemⅡ. Results The esophageal hiatus was 1.5-3.5cm of diameter, with average of 2.5cm in 26 patinets, and 20 patients were identifed to suffer from hiatus hernia. The plicae were within 3cm from the squamocolumnar junction or gastroesophageal stoma, sutured on the lesser curve with linear configuration in 11 patients, around the cardiac orifice with circumferential configuration in 17 cases and with the combinatin of both configurations in 4 patients. The distance was 1-3cm between two stitchs and 1.5-2cm between two folds. 32 procedures were finished in 26 patiensts with total of 60 plicae, a repeat procedure was performed on 6 patients. Each patient was sutured for 1-4 plicae with a average of 2.3 plicae. The hearburn and regurgitation was improved in 76% of patients, resolved completely in 36% of patients and remitted partly in 40% of patients. One patient occurred dyspnoea during operation as having suffered a cold and the others were free of serious complications. Conclusion The symptoms of GERD can be significantly improved with ELGP which indicated in GERD with 3 or more heartburn or regurgitation episodes per week,1-3cm hiatus hernia or resection of cardiac orifice. The procedures generally show convenient and safety,but it is not indication for the patients with acut cold, serious pulmonary or heart diseases.
Key Words Gastroesophageal reflux disease; Endoluminal gasrtroplication; Endoscopic gastroplasty.