A 44-year-old man with a 6-year history of gastroesophageal reflux disease (GERD;
score of 30 on GERD questionnaire) underwent an upper gastrointestinal (GI) endoscopy,
which revealed esophagitis (Los Angeles grade A). After failure of maximal medical
therapy for GERD, the patient underwent a new minimally invasive, reversible endoscopic
treatment, with the aim of predicting whether his symptoms could be alleviated, in
order to ultimately decide whether to undergo irreversible surgery or endoscopic treatment.
A novel LeCamp endoloop (Leo Medical, China) ([Fig. 1]) was inserted into the gastric cardia using forceps passed through a single-channel
endoscope ([Fig. 2 a]). After adjustment of the location and angle of the endoloop, it was anchored onto
the edge of the gastric cardia with a clip ([Fig. 2 b]) and another one or two clips were inserted to hold the opposite side of endoloop
about halfway round the circumference ([Fig. 2 c]). The hook was then connected with the endoloop ([Fig. 2 d]), which was tightened with a slight pulling together of all the clips ([Fig. 2 e]). The patient did not experience any pain and was safely discharged the same day.
Fig. 1 The LeCamp endoloop.
Fig. 2 White-light endoscopy views showing: a the gastric cardia; b the endoloop being fixed with the first clip using forceps passed through a single-channel
endoscope; c a second clip being applied halfway around the circumference of the cardia; d the hook being connected to tighten the endoloop; e the gastric cardia in retroflexed view after the endoloop has been fixed and tightened.
After the treatment, the patient showed significant improvement in his symptoms with
a score of 4 points on the GERD questionnaire and was able to discontinue daily use
proton pump inhibitors. At 1-month follow-up, the patient complained that the symptoms
were gradually re-appearing, repeat upper GI endoscopy revealed the endoloop and the
clips had dropped off. After the patient had given his consent, anti-reflux mucosectomy
(ARMS) was performed using standard endoscopic submucosal dissection [1]. At the 3-month follow-up, he reported significant reduction in GERD questionnaire
scores and his upper GI endoscopy showed a tight gastroesophageal junction ([Fig. 3]).
Fig. 3 Endoscopic appearance 3 months after undergoing anti-reflux mucosectomy showing a
tight gastroesophageal junction.
In this patient, we used a novel pretest to narrow the gastric cardia before he underwent
ARMS, which suggests that this new technique may be a simple and reversible method
to control symptoms temporarily in GERD patients, while they decide whether to undergo
irreversible surgery or endoscopic treatment.
Video 1 A novel endoloop pretest to treat severe gastroesophageal reflux disease symptoms
before anti-reflux mucosectomy in a 44-year-old man.
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AC
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