Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 7, 2012; 18(41): 5940-5947
Published online Nov 7, 2012. doi: 10.3748/wjg.v18.i41.5940
Efficacy of endoluminal gastroplication in Japanese patients with proton pump inhibitor-resistant, non-erosive esophagitis
Kentaro Tokudome, Yasushi Funaki, Makoto Sasaki, Shinya Izawa, Yasuhiro Tamura, Akihito Iida, Naotaka Ogasawara, Toshihiro Konagaya, Yoshifumi Tokura, Kunio Kasugai
Kentaro Tokudome, Yasushi Funaki, Makoto Sasaki, Shinya Izawa, Yasuhiro Tamura, Akihito Iida, Naotaka Ogasawara, Kunio Kasugai, Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi 480-1195, Japan
Yasushi Funaki, Department of Clinical Laboratory, Aichi Medical University School of Medicine, Aichi 480-1195, Japan
Toshihiro Konagaya, Marine Clinic, Nagoya, Aichi 460-0002, Japan
Yoshifumi Tokura, Tokura Yoshifumi Stomach and Intestines Internal Medicine Clinic, Kyoto 615-8256, Japan
Author contributions: Tokudome K, Funaki Y and Kasugai K designed the research; Izawa S, Tamura Y and Iida A contributed to perform experiments in the study; Konagaya T, Tokura Y and Sasaki M analyzed data; and Ogasawara N, Tokudome K and Kasugai K wrote the paper.
Supported by In Part by a Grant for Medical Research from Aichi Medical University School of Medicine
Correspondence to: Kentaro Tokudome, MD, Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan. namike@aichi-med-u.ac.jp
Telephone: +81-561-623311 Fax: +81-561-621508
Received: June 9, 2012
Revised: July 16, 2012
Accepted: July 18, 2012
Published online: November 7, 2012
Abstract

AIM: To evaluate the efficacy, safety, and long-term outcomes of endoluminal gastroplication (ELGP) in patients with proton pump inhibitor (PPI)-resistant, non-erosive reflux disease (NERD).

METHODS: The subjects were NERD patients, diagnosed by upper endoscopy before PPI use, who had symptoms such as heartburn or reflux sensations two or more times a week even after 8 wk of full-dose PPI treatment. Prior to ELGP, while continuing full-dose PPI medication, patients’ symptoms and quality of life (QOL) were assessed using the questionnaire for the diagnosis of reflux disease, the frequency scale for symptoms of gastro-esophageal reflux disease (FSSG), gastrointestinal symptoms rating scale, a 36-item short-form. In addition, 24-h esophageal pH monitoring or 24-h intraesophageal pH/impedance (MII-pH) monitoring was performed. The Bard EndoCinchTM was used for ELGP, and 2 or 3 plications were made. After ELGP, all acid reducers were temporarily discontinued, and medication was resumed depending on the development and severity of symptoms. Three mo after ELGP, symptoms, QOL, pH or MII-pH monitoring, number of plications, and PPI medication were evaluated. Further, symptoms, number of plications, and PPI medication were evaluated 12 mo after ELGP to investigate long-term effects.

RESULTS: The mean FSSG score decreased significantly from before ELGP to 3 and 12 mo after ELGP (19.1 ± 10.5 to 10.3 ± 7.4 and 9.3 ± 9.9, P < 0.05, respectively). The total number of plications decreased gradually at 3 and 12 mo after ELGP (2.4 ± 0.8 to 1.2 ± 0.8 and 0.8 ± 1.0, P < 0.05, respectively). The FSSG scores in cases with no remaining plications and in cases with one or more remaining plications were 4.4 and 2.7, respectively, after 3 mo, and 2.0 and 2.8, respectively, after 12 mo, showing no correlation to plication loss. On pH monitoring, there was no difference in the percent time pH < 4 from before ELGP to 3 mo after. Impedance monitoring revealed no changes in the number of reflux episodes or the symptom index for reflux events from before ELGP to 3 mo after, but the symptom sensitivity index decreased significantly 3 mo after ELGP (16.1 ± 12.9 to 3.9 ± 8.3, P < 0.01). At 3 mo after ELGP, 6 patients (31.6%) had reduced their PPI medication by 50% or more, and 11 patients (57.9%) were able to discontinue PPI medication altogether. After 12 mo, 3 patients (16.7%) were able to reduce the amount of PPI medication by 50% or more, and 12 patients (66.7%) were able to discontinue PPI medication altogether. A high percentage of cases with remaining plications had discontinued PPIs medication after 3 mo, but there was no difference after 12 mo. No serious complications were observed in this study.

CONCLUSION: ELGP was safe, resulted in significant improvement in subjective symptoms, and allowed less medication to be used over the long term in patients with PPI-refractory NERD.

Keywords: Endoluminal gastroplication; Esophageal pH; Gastro-esophageal reflux disease; Non-erosive reflux disease; Proton pump inhibitor-resistant