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Published in:

01-04-2010

Effect of Transoral Incisionless Fundoplication on Symptoms, PPI Use, and pH-Impedance Refluxes of GERD Patients

Authors: Pier Alberto Testoni, Maura Corsetti, Salvatore Di Pietro, Antonio Gianluca Castellaneta, Cristian Vailati, Enzo Masci, Sandro Passaretti

Published in: World Journal of Surgery | Issue 4/2010

Abstract

Background

Three previous studies from the same institution have reported that transoral incisionless fundoplication (TIF) with the EsophyX device is effective for creating a continent gastroesophageal valve and for good functional results as measured only by pH-metry in patients with gastroesophageal reflux disease (GERD). The objective of the present study was to evaluate the effect of TIF on symptoms, use of proton pump inhibitors (PPI), esophageal motility, and pH-impedance in patients with symptomatic GERD.

Methods

Twenty consecutive patients were enrolled to complete the GERD-HRQL and GERD-QUAL questionnaires while on and off PPI. They were also examined by upper gastrointestinal (GI) endoscopy to determine Hill grade and Jobe length of the gastroesophageal valve, and to check for hiatal hernia and esophagitis, esophageal manometry, and pH-impedance before and 6 months after TIF.

Results

Six months after TIF, the GERD-HRLQ and GERD-QUAL scores off-PPI therapy and the number of total and acid pH-impedance refluxes were significantly reduced (p < 0.05). The PPI had been completely stopped in 55% of the patient and was reduced in 22% of the patients.

Conclusions

At 6-month follow-up, TIF performed using the EsophyX device reduces symptoms and pH-impedance refluxes, allowing interruption or reduction of PPI use in 78% of patients with GERD.

Dent J, Armstrong D, Delaney B et al (2004) Symptoms evaluation in reflux disease: workshop background processes; terminology, recommendation and discussion outputs. Gut 53:1–24CrossRef

De Vault KR, Castell DO (2005) American College of Gastroenterology update guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 100:190–200CrossRef

Anon R (1999) An evidence-based appraisal of reflux disease management: the Genval workshop report. Gut 44(Suppl 2):S1–S16

Locke GR, Talley NJ, Fett SL et al (1997) Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 112:1448–1456CrossRefPubMed

Richter JE (2007) The many manifestations of gastro-esophageal reflux disease: presentation, evaluation, and treatment. Gastroenterol Clin North Am 36:577–599CrossRefPubMed

Lundell L, Miettinen P (2001) Continued (5 years) follow up of a randomized clinical study comparing antireflux surgery and omeprazole in GERD. J Am Coll Surg 192:171–182

Draaisma WE, Rijnhart-de Jong HG, Broeders IAMJ et al (2006) Five-year subjective and objective results of laparoscopic and conventional Nissen fundoplication. Ann Surg 244:34–41CrossRefPubMed

Triadafilopoulos G (2007) Endotherapy and surgery for GERD. J Clin Gastroenterol 41(Suppl 2):S87–S96CrossRefPubMed

Portale G, Filipi CJ, Peters JH (2004) A current assessment of endoluminal approaches to the treatment of gastroesophageal reflux disease. Surg Innov 4:225–234CrossRef

10.

Fry LC, Monkemuller K, Malfertheiner P (2007) Systematic review. Endoluminal therapy for gastro-oesophageal reflux disease: evidence from clinical trials. Eur J Gastroenterol Hepatol 19:1125–1139CrossRefPubMed

11.

Cadière GB, Rajan A, Rquibate M et al (2006) Endoluminal fundoplication (ELF)—evolution of EsophyX, a new surgical device for transoral surgery. Minimally Invasive Ther 15:348–355CrossRef

12.

Cadiere GB, Rajan A, Germay O et al (2008) Endoluminal fundoplication by a transoral device for the treatment of GERD: a feasibility study. Surg Endosc 22:333–342CrossRefPubMed

13.

Cadiere GB, Buset M, Muls V et al (2008) Antireflux transoral incisionless fundoplication using EsophyX: 12-month results of a prospective multicenter study. World J Surg 32:1676–1688CrossRefPubMed

14.

Cadiere GB, Van Sante N, Graves JE et al (2009) Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX. Surg Endosc 23:957–964CrossRefPubMed

15.

Drossman DA (2006) The functional gastrointestinal disorders and the Rome III process. Gastroenterology 130:1377–1390CrossRefPubMed

16.

Lundell LR, Dent J, Bennett JR et al (1999) Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 45:172–180CrossRefPubMed

17.

Velanovich V, Vallance SR, Gusz JR et al (1996) Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 183:217–224PubMed

18.

Raymond JM, Marquis P, Bechade D et al (1999) Assessment of quality of life of patients with gastroesophageal reflux. Elaboration and validation of a specific questionnaire. Gastroenterol Clin Biol 23:32–39PubMed

19.

Jobe BA, Kahrilas PJ, Vernon AH et al (2004) Endoscopic appraisal of the gastroesophageal valve after antireflux surgery. Am J Gastroenterol 99:233–243CrossRefPubMed

20.

Jobe BA, O’Rourke RW, McMahon BP et al (2008) Transoral endoscopic fundoplication in the treatment of gastroesophageal reflux disease. The anatomic and physiologic basis for reconstruction of the esophago-gastric junction using a novel device. Ann Surg 248:69–76CrossRefPubMed

21.

Hill D, Kozarek RA (1999) The gastroesophageal flap valve. J Clin Gastroenterol 28:194–197CrossRefPubMed

22.

Malmud LS, Fischer RS, Knight LC et al (1982) Scintigraphic evaluation of gastric emptying. Semin Nucl Med 12:116–125CrossRefPubMed

23.

Passaretti S, Zaninotto G, Di Martino N et al (2000) Standards for esophageal manometry. A position statement of GISMAD. Dig Liver Dis 32:46–55CrossRefPubMed

24.

Sifrim D, Castell D, Dent J et al (2004) Gastroesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid and gas reflux. Gut 53:1024–1031CrossRefPubMed

25.

Zerbib F, des Varannes SB, Roman S et al (2005) Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther 22:1011–1021CrossRefPubMed

26.

Fornari F, Sifrim D (2008) Diagnostic options for patients with refractory GERD. Curr Gastroenterol Rep 10:283–288CrossRefPubMed

27.

Khajanchee YS, Ujiki M, Dunst CM et al (2009) Patient factors predictive of 24-h pH normalization following endoluminal gastroplication for GERD. Surg Endosc [E-pub ahead of publication Saturday, May 09, 2009]

Title: Effect of Transoral Incisionless Fundoplication on Symptoms, PPI Use, and pH-Impedance Refluxes of GERD Patients
Authors: Pier Alberto Testoni
Maura Corsetti
Salvatore Di Pietro
Antonio Gianluca Castellaneta
Cristian Vailati
Enzo Masci
Sandro Passaretti
Publication date: 01-04-2010
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 4/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-010-0394-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of Transoral Incisionless Fundoplication on Symptoms, PPI Use, and pH-Impedance Refluxes of GERD Patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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