Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 5/2010

01-05-2010

Evaluating outcomes of endoscopic full-thickness plication for gastroesophageal reflux disease (GERD) with impedance monitoring

Authors: Daniel von Renteln, Arthur Schmidt, Bettina Riecken, Karel Caca

Published in: Surgical Endoscopy | Issue 5/2010

Login to get access

Abstract

Background

Endoscopic full-thickness plication allows transmural suturing at the gastroesophageal junction to recreate the antireflux barrier. Multichannel intraluminal impedance monitoring (MII) can be used to detect nonacid or weakly acidic reflux, acidic swallows, and esophageal clearance time. This study used MII to evaluate the outcome of endoscopic full-thickness plication.

Methods

In this study, 12 subsequent patients requiring maintenance proton pump inhibitor therapy underwent endoscopic full-thickness plication for treatment of gastroesophageal reflux disease. With patients off medication, MII was performed before and 6-months after endoscopic full-thickness plication.

Results

The total median number of reflux episodes was significantly reduced from 105 to 64 (p = 0.016). The median number of acid reflux episodes decreased from 73 to 43 (p = 0.016). Nonacid reflux episodes decreased from 23 to 21 (p = 0.306). The median bolus clearance time was 12 s before treatment and 11 s at 6 months (p = 0.798). The median acid exposure time was reduced from 6.8% to 3.4% (p = 0.008), and the DeMeester scores were reduced from 19 to 12 (p = 0.008).

Conclusion

Endoscopic full-thickness plication significantly reduced total reflux episodes, acid reflux episodes, and total reflux exposure time. The DeMeester scores and total acid exposure time for the distal esophagus were significantly improved. No significant changes in nonacid reflux episodes and median bolus clearance time were encountered.
Literature
1.
Dent J, El-Serag HB, Wallander MA, Johansson S (2005) Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 54:710–717CrossRefPubMed
2.
Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R (2006) The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101:1900–1920CrossRefPubMed
3.
Klinkenberg-Knol EC, Festen HP, Meuwissen SG (1995) Pharmacological management of gastro-oesophageal reflux disease. Drugs 49:695–710CrossRefPubMed
4.
Pace F, Santalucia F, Bianchi Porro G (1991) Natural history of gastro-oesophageal reflux disease without oesophagitis. Gut 32:845–848CrossRefPubMed
5.
Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, Castell DO (2006) Acid and nonacid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut 55:1398–1402CrossRefPubMed
6.
Sifrim D, Castell D, Dent J, Kahrilas PJ (2004) Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut 53:1024–1031CrossRefPubMed
7.
Zerbib F, Duriez A, Roman S, Capdepont M, Mion F (2008) Determinants of gastro-oesophageal reflux perception in patients with persistent symptoms despite proton pump inhibitors. Gut 57:156–160CrossRefPubMed
8.
Schilling D, Kiesslich R, Riemann JF, Riemann JF (2005) Endoluminal therapy of GERD with a new endoscopic suturing device. Gastrointest Endosc 62:37–43CrossRefPubMed
9.
Pleskow D, Rothstein R, Kozarek R, Haber G, Gostout C, Lembo A (2006) Endoscopic full-thickness plication for the treatment of GERD: long-term multicenter results. Surg Endosc 21:439–444CrossRefPubMed
10.
McClusky DA, Khaitan L, Swafford VA, Smith CD (2007) Radiofrequency energy delivery to the lower esophageal sphincter (Stretta procedure) in patients with recurrent reflux after antireflux surgery: can surgery be avoided? Surg Endosc 21:1207–1211CrossRefPubMed
11.
Triadafilopoulos G, Di Baise JK, Nostrant TT, Stollman NH, Anderson PK, Wolfe MM, Rothstein RI, Wo JM, Corley DA, Patti MG, Antignano LV, Goff JS, Edmundowicz SA, Castell DO, Rabine JC, Kim MS, Utley DS (2002) The Stretta procedure for the treatment of GERD: 6- and 12-month follow-up of the U.S. open label trial. Gastrointest Endosc 55:149–156CrossRefPubMed
12.
Tam WCE, Schoeman MN, Zhang Q, Dent J, Rigda R, Utley D, Holloway RH (2003) Delivery of radiofrequency energy to the lower oesophageal sphincter and gastric cardia inhibits transient lower oesophageal sphincter relaxations and gastro-oesophageal reflux in patients with reflux disease. Gut 52:479–485CrossRefPubMed
13.
Birk J, Pruitt R, Haber G, Raijman I, Baluyut A, Meiselman M, Sedghi S (2009) The Plicator procedure for the treatment of gastroesophageal reflux disease: a registry study. Surg Endosc 23:423–431CrossRefPubMed
14.
Corley DA, Katz P, Wolfe MM, Stefan A, Patti M, Rothstein R, Edmundowicz S, Kline M, Mason R, Wolfe MM (2003) Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial. Gastroenterology 125:668–676CrossRefPubMed
15.
Pleskow D, Rothstein R, Kozarek R, Haber G, Gostout C, Lembo A (2008) Endoscopic full-thickness plication for the treatment of GERD: five-year long-term multicenter results. Surg Endosc 22:326–332CrossRefPubMed
16.
Deviere J, Costamagna G, Neuhaus H, Voderholzer W, Louis H, Tringali A, Marchese M, Fiedler T, Darb-Esfahani P, Schumacher B (2005) Nonresorbable copolymer implantation for gastroesophageal reflux disease: a randomized sham-controlled multicenter trial. Gastroenterology 128:532–540CrossRefPubMed
17.
Rothstein R, Filipi C, Caca K, Pruitt R, Mergener K, Torquati A, Haber G, Chen Y, Chang K, Wong D, Deviere J, Pleskow D, Lightdale C, Ades A, Kozarek R, Richards W, Lembo A (2006) Endoscopic full-thickness plication for the treatment of gastroesophageal reflux disease: a randomized, sham-controlled trial. Gastroenterology 131:704–712CrossRefPubMed
18.
Schiefke I, Zabel-Langhennig S, Neumann S, Feisthammel J, Moessner J, Caca K (2005) Long-term failure of endoscopic gastroplication (EndoCinch). Gut 54:752–758CrossRefPubMed
19.
von Renteln D, Brey U, Riecken B, Caca K (2008) Endoscopic full-thickness plication (Plicator) with two serially placed implants improves esophagitis, reduces PPI use and esophageal acid exposure. Endoscopy 40:173–178CrossRef
20.
von Renteln D, Schiefke I, Fuchs K, Raczynski S, Philipper M, Breithaupt W, Caca K, Neuhaus H (2008) Endoscopic full-thickness plication for the treatment of gastroesophageal reflux disease by application of multiple plicator implants: a multicenter study. Gastrointest Endosc 68:833–844CrossRef
21.
Sgromo B, Irvine LA, Cuschieri A, Shimi SM (2008) Long-term comparative outcome between laparoscopic total Nissen and Toupet fundoplication: symptomatic relief, patient satisfaction, and quality of life. Surg Endosc 22:1048–1053CrossRefPubMed
22.
Johnson LF, De Meester TR (1974) Twenty-four-hour pH monitoring of the distal esophagus: a quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62:325–332PubMed
23.
Shay S, Richter JE (1998) Importance of additional reflux events during esophageal acid clearing. Dig Dis Sci 43:95–102CrossRefPubMed
24.
Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, Zhang X, Adhami T, Murray J, Peters J, Castell D (2004) Twenty-four-hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 99:1037–1043CrossRefPubMed
25.
Johnsson F, Joelsson B, Isberg PE (1987) Ambulatory 24-hour intraesophageal pH-monitoring in the diagnosis of gastroesophageal reflux disease. Gut 28:1145–1150CrossRefPubMed
26.
Emde C, Garner A, Blum AL (1987) Technical aspects of intraluminal pH-metry in man: current status and recommendations. Gut 28:1177–1188CrossRefPubMed
27.
Fletcher J, Wirz A, Henry E, McColl KEL (2004) Studies of acid exposure immediately above the gastro-oesophageal squamocolumnar junction: evidence of short segment reflux. Gut 53:168–173CrossRefPubMed
28.
Pandolfino JE, Zhang Q, Schreiner MA, Ghosh S, Roth MP, Kahrilas PJ (2005) Acid reflux event detection using the Bravo wireless versus the Slimline catheter pH systems: why are the numbers so different? Gut 54:1687–1692CrossRefPubMed
29.
Bredenoord AJ, Weusten BLAM, Smout AJ (2005) Symptom association analysis in ambulatory gastro-oesophageal reflux monitoring. Gut 54:1810–1817CrossRefPubMed
30.
Sifrim D, Silny J, Holloway RH, Janssens J (1999) Patterns of gas and liquid reflux during transient lower oesophageal sphincter relaxation: a study using intraluminal electrical impedance. Gut 44:47–54PubMedCrossRef
31.
Tutuian R, Castell DO (2003) Use of multichannel intraluminal impedance to document proximal esophageal and pharyngeal nonacidic reflux episodes. Am J Med 115:119–123CrossRef
32.
Sifrim D, Dupont L, Blondeau K, Tack J, Janssens J (2005) Weakly acidic reflux in patients with chronic unexplained cough during 24-hour pressure, pH, and impedance monitoring. Gut 54:449–454CrossRefPubMed
33.
Tutuian R, Castell DO (2004) Combined multichannel intraluminal impedance and manometry clarifies esophageal function abnormalities: study in 350 patients. Am J Gastroenterol 99:1011–1019CrossRefPubMed
34.
Bredenoord AJ, Weusten BL, Timmer R, Smout AJ (2006) Characteristics of gastroesophageal reflux in symptomatic patients with and without excessive esophageal acid exposure. Am J Gastroenterol 101:2470–2475PubMed
35.
Bredenoord AJ, Weusten BLAM, Sifrim D, Timmer R, Smout AJ (2004) Aerophagia, gastric, and supragastric belching: a study using intraluminal electrical impedance monitoring. Gut 53:1561–1565CrossRefPubMed
36.
Balaji NS, Blom D, De Meester TR, Peters JH (2003) Redefining gastroesophageal reflux (GER). Surg Endosc 17:1380–1385CrossRefPubMed
37.
Gruebel C, Linke G, Tutuian R, Hebbard G, Zerz A, Meyenberger C, Borovicka J (2008) Prospective study examining the impact of multichannel intraluminal impedance on antireflux surgery. Surg Endosc 22:1241–1247CrossRefPubMed
38.
del Genio G, Tolone S, del Genio F, Rossetti G, Brusciano L, Pizza F, Fei L, del Genio A (2008) Total fundoplication controls acid and nonacid reflux: evaluation by pre- and postoperative 24-h pH-multichannel intraluminal impedance. Surg Endosc 22:2518–2523CrossRefPubMed
39.
Torquati A, Richards WO (2007) Endoluminal GERD treatments: critical appraisal of current literature with evidence-based medicine instruments. Surg Endosc 21:697–706CrossRefPubMed
40.
Hogan WJ (2006) Clinical trials evaluating endoscopic GERD treatments: is it time for a moratorium on the clinical use of these procedures? Am J Gastroenterol 101:437–439CrossRefPubMed
41.
Freston JW, Triadafilopoulos G (2004) Review article: approaches to the long-term management of adults with GERD-proton pump inhibitor therapy, laparoscopic fundoplication or endoscopic therapy? Aliment Pharmacol Ther 19:35–42CrossRefPubMed
42.
Gerson LB, Triadafilopoulos G (2001) Proton pump inhibitors and their drug interactions: an evidence-based approach. Eur J Gastroenterol Hepatol 13:611–616CrossRefPubMed
43.
Rosen R, Nurko S, Furuta GT (2003) Impeding gastroesophageal refluxate: a new application of an old medication. Gastroenterology 125:984–985CrossRefPubMed
44.
45.
Strate U, Emmermann A, Fibbe C, Layer P, Zornig C (2008) Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surg Endosc 22:21–30CrossRefPubMed
46.
Guerin E, Betroune K, Closset J, Mehdi A, Lefebvre JC, Houben JJ, Gelin M, Vaneukem P, El Nakadi I (2007) Nissen versus Toupet fundoplication: results of a randomized and multicenter trial. Surg Endosc 21:1985–1990CrossRefPubMed
47.
Biertho L, Sebajang H, Anvari M (2006) Effects of laparoscopic Nissen fundoplication on esophageal motility: long-term results. Surg Endosc 20:619–623CrossRefPubMed
48.
Oelschlager BK, Lal DR, Jensen E, Cahill M, Quiroga E, Pellegrini CA (2006) Medium- and long-term outcome of laparoscopic redo fundoplication. Surg Endosc 20:1817–1823CrossRefPubMed
49.
Youssef YK, Shekar N, Lutfi R, Richards WO, Torquati A (2006) Long-term evaluation of patient satisfaction and reflux symptoms after laparoscopic fundoplication with Collis gastroplasty. Surg Endosc 20:1702–1705CrossRefPubMed
50.
Biertho L, Sebajang H, Allen C, Anvari M (2006) Does laparoscopic Nissen fundoplication lead to chronic gastrointestinal dysfunction? Surg Endosc 20:1360–1363CrossRefPubMed
51.
Zehetner J, Holzinger F, Breuhahn T, Geppert C, Klaiber C (2006) Five-year results of laparoscopic Toupet fundoplication as the primary surgical repair in GERD patients: is it durable? Surg Endosc 20:220–225CrossRefPubMed
52.
Papasavas PK, Keenan RJ, Yeaney WW, Caushaj PF, Gagne DJ, Landreneau RJ (2003) Effectiveness of laparoscopic fundoplication in relieving the symptoms of gastroesophageal reflux disease (GERD) and eliminating antireflux medical therapy. Surg Endosc 17:1200–1205CrossRefPubMed
53.
Contini S, Bertele A, Nervi G, Zinicola R, Scarpignato C (2002) Quality of life for patients with gastroesophageal reflux disease 2 years after laparoscopic fundoplication. Evaluation of the results obtained during the initial experience. Surg Endosc 16:1555–1560CrossRefPubMed
54.
Mainie I, Tutuian R, Agrawal A, Adams D, Castell DO (2006) Combined multichannel intraluminal impedance pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg 93:1483–1487CrossRefPubMed
Metadata
Title
Evaluating outcomes of endoscopic full-thickness plication for gastroesophageal reflux disease (GERD) with impedance monitoring
Authors
Daniel von Renteln
Arthur Schmidt
Bettina Riecken
Karel Caca
Publication date
01-05-2010
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 5/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-009-0723-9

Other articles of this Issue 5/2010

Surgical Endoscopy 5/2010 Go to the issue

New Technology

NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance

OriginalPaper

Testing the construct validity of the Simbionix GI Mentor II virtual reality colonoscopy simulator metrics: module matters

OriginalPaper

Increased vascular endothelial growth factor transcription in residual hepatocellular carcinoma after open versus laparoscopic hepatectomy in a small animal model

Video

Mixed reality for robotic treatment of a splenic artery aneurysm

OriginalPaper

Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes

OriginalPaper

High-resolution endoscopy and endoscopic ultrasound for evaluation of early neoplasia in Barrett’s esophagus