Background and study aims: In patients with gastroesophageal reflux disease (GERD), temporary electrical stimulation
of the lower esophageal sphincter (LES) increases LES pressure without interference
with LES relaxation. The aim of the current study was to investigate the safety and
efficacy of long term LES electrical stimulation therapy (LES–EST), using a permanently
implanted stimulator for the treatment of GERD.
Patients and methods: Patients with GERD who were at least partially responsive to proton pump inhibitors
(PPIs) and who had hiatal hernia of ≤ 3 cm and esophagitis of Los Angeles Grade A,
B, or C were included in the study. Stimulation electrodes were placed in the LES
and a pulse generator (EndoStim LES Stimulation System; EndoStim BV, The Hague, The
Netherlands) was implanted laparoscopically. LES stimulation was delivered at 20 Hz,
215 μs, 3 – 8 mA in multiple 30-minute sessions. Patients were evaluated at follow-up
using the GERD Health-Related Quality of Life (HRQL) questionnaire, daily symptom
and medication diaries, the SF-12 Health Survey, esophageal pH testing, and high resolution
manometry.
Results: A total of 24 patients (mean age 53 ± 12 years; 14 men) were implanted and 23 completed
the 12-month evaluation. No serious implantation or stimulation-related adverse affects
or sensations were reported. Median composite GERD–HRQL score at 12 months was 2.0
(interquartile range [IQR] 0 – 3.0), which was significantly better than baseline
scores both on PPI therapy (median 9.0, IQR 6.0 – 10.0; P = 0.002) and off PPIs (median 23.5, IQR 21 – 25.75; P < 0.001). The median percentage of the 24-hour period with esophageal pH < 4.0 at
baseline was 10.1 % (IQR 7.7 – 15.5), which was reduced to 3.3 % (1.8 – 6.9) at 12
months (P < 0.001), with 69 % of patients showing either normalization or > 50 % improvement
in their distal esophageal pH. At 12 months, 96 % of patients (22/23) were completely
off PPI medication.
Conclusion: During the long term follow-up of 12 months, LES – EST was safe and effective for
the treatment of GERD. There was a significant and sustained improvement in GERD symptoms,
reduction in esophageal acid exposure with elimination of daily PPI usage, and no
stimulation-related adverse effects.
