Initial experience with a novel resection and plication (RAP) method for acid reflux: a pilot study

Abstract

Background and study aims Current endoscopic therapies for gastroesophageal reflux disorder (GERD) are limited by technical complexity, and/or cost. We sought to evaluate the success of a novel resection and plication (RAP) anti-reflux procedure.

Patients and methods RAP was performed on 10 patients with GERD refractory to proton pump inhibitor (PPI) therapy. RAP consists of semi-circumferential mucosectomy along with full-thickness plication of the lower esophageal sphincter (LES) and cardia. We assessed the technical success and safety as well as followed GERD-Health Related Quality of Life (GERD-HRQL) scores and medication usage.

Results All patients underwent RAP without adverse events and were discharged on the same day. Only half of the patients required general anesthesia. Follow-up ranged from 5 to 24 months (median 9 months) and all patients had a significant improvement in their GERD-HRQL scores (P < 0.0001, 95 % CI 19.3 – 25.3). 8 of 10 eliminated their daily PPI dependence.

Conclusions The RAP method has potential as an effective anti-reflux option. Its main advantages include a short procedure time, simple approach using readily available equipment, and possible avoidance of general anesthesia.

• References

• 1 Gawron AJ, French DD, Pandolfino JE. et al. Economic evaluations of gastroesophageal reflux disease medical management. Pharmacoeconomics 2014; 32: 745-758
• 2 Miller LS, Vegesna AK, Brasseur JG. et al. The esophagogastric junction Ann. N.Y. Acad. Sci 2011; 1232: 323-330
• 3 Miller L, Vegesna A, Kalra A. et al. New Observations on the Gastroesophageal Antireflux Barrier. Gastroenterol Clin N Am 2007; 36: 601-617
• 4 Brasseur JG, Ulerich R, Dai Q. et al. Pharmacological dissection of the human gastro-oesophageal segment into three sphincteric components. J Physiol 2007; 580: 961-975
• 5 Winans CS. Manometric asymmetry of the lower-esophageal high-pressure zone. Am J Dig Dis 1977; 22: 348-354
• 6 Menezes MA, Herbella FA. Pathophysiology of gastroesophageal reflux disease. World J Surg 2017; 41: 1661-1671
• 7 Huang X, Chen S, Zhao H. et al. Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc 2017; 31: 1032-1044
• 8 Testoni PA, Testoni S, Mazzoleni G. et al. Long-term efficacy of transoral incisionless fundoplication with Esophyx (Tif 2.0) and factors affecting outcomes in GERD patients followed for up to 6 years: a prospective single-center study. Surg Endosc 2015; 29: 2770-2780
• 9 Witteman BP, Conchillo JM, Rinsma NF. et al. Randomized controlled trial of transoral incisionless fundoplication vs. proton pump inhibitors for treatment of gastroesophageal reflux disease. Am J Gastroenterol 2015; 110: 531-542
• 10 Inoue H, Ito H, Ikeda H. et al. Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: a pilot study. Ann Gastroenterol 2014; 27: 346-351
• 11 Ozawa S, Kumai K, Higuchi K. et al. Short-term and long-term outcome of endoluminal gastroplication for the treatment of GERD: the first multicenter trial in Japan. J Gastroenterol 2009; 44: 675-684
• 12 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 13 Schnoll-Sussman F, Katz PO. Clinical implications of emerging data on the safety of proton pump inhibitors. Curr Treat Options Gastroenterol 2017; 15: 1-9
• 14 Madan K, Ahuja V, Gupta SD. et al. Impact of 24-h esophageal pH monitoring on the diagnosis of gastroesophageal reflux disease: defining the gold standard. J Gastroenterol Hepatol 2005; 20: 30-37
• 15 Fass R, Ofman JJ, Sampliner RE. et al. The omeprazole test is as sensitive as 24-h oesophageal pH monitoring in diagnosing gastro-oesophageal reflux disease in symptomatic patients with erosive oesophagitis. Aliment Pharmacol Ther 2000; 14: 389-396
• 16 Dai Q, Brasseur JG, Dimitriou J. et al. 2-D and 3-D endoluminal ultrasound localization of endoscopic plications with simultaneous manometry. Gastrointest Endosc 2004; 59: 244