Long term failure of endoscopic gastroplication (EndoCinch)

Abstract

Introduction: Endoluminal gastroplication (EndoCinch; Bard) has been introduced as an endoscopic treatment option in gastro-oesophageal reflux disease (GORD) patients with promising short term results. However, little is known about the long term efficacy of endoscopic suturing. The aim of this study was to evaluate prospectively the long term outcome after EndoCinch. Patients and methods: A total of 70 patients treated with EndoCinch at a single referral centre were studied prospectively. All patients were interviewed using a standardised questionnaire regarding their symptoms and medication prior to and 18 months after EndoCinch. In addition, follow up included endoscopy, 24 hour pH monitoring, and oesophageal manometry. Results: The procedure was well tolerated without major short or long term complications. Eighteen months after EndoCinch, 56/70 patients (80%) were considered treatment failures as their heartburn symptoms did not improve or proton pump inhibitor medication exceeded 50% of the initial dose. Endoscopy showed all sutures in situ in 12/70 (17%) patients while no remaining sutures could be detected in 18/70 (26%). In 54 and 50 patients examined, respectively, no significant changes in 24 hour pH monitoring (median pH ,4/24 hours, 9.1% v 8.5%; p = 0.82) or lower oesophageal sphincter (LOS) pressure (7.7 v 10.3 mm Hg; p = 0.051) were observed while median LOS length slightly increased (3.0 to 3.2 cm; p,0.05). Conclusion: Endoscopic gastroplication (EndoCinch) is a safe and minimally invasive endoscopic treatment for GORD with reasonable short term results. In contrast, long term outcome is disappointing, probably due to suture loss in the majority of patients. Therefore, technical improvements to ensure suture durability are mandatory before endoscopic suturing can evolve as a therapeutic option for GORD treatment.

EndoCinch® Treatment for Gastro-Oesophageal Reflux Disease

“…In the sham-controlled study reported by Schwartz et al [48], endoscopy/gastroplication was performed only in patients of the active treatment group who had treatment failure, and hence the actual proportion of patients who have retention of stitches (or judged to be functional) is unknown in this group. However, retention of stitches seems to be a major problem reported with this technique [48, 52, 53]. Further studies are needed to confirm the above.…”

“…Loss of plications has been reported both with the knot technique [43] as well as with the clip device [52] used for anchoring the sutures, but seems to be more frequently with the latter. In the sham-controlled study reported by Schwartz et al [48], endoscopy/gastroplication was performed only in patients of the active treatment group who had treatment failure, and hence the actual proportion of patients who have retention of stitches (or judged to be functional) is unknown in this group.…”

Updates on Management of GERD Disease

“…These procedures are less invasive alternatives of laparoscopy. The Esophyx device [34], for the TIF method, which means Transoral Incisionless Fundoplication, is manufactured by EndoGastric Solution and allows the creation of a fundoplication esophagogastric of 2-3 cm thick, for circumferential extension of 270°, capturing the mucous tissue with 12 or more points of polypropylene suture. The device is used in combination with an endoscope flexible video, which provides the endoscopic visualization thoughout the operation.…”

Endoscopic Therapy for Gastroesophageal Reflux Disease: A Systematic Review

“…The percentage of patients who did not require PPIs decreased from 52% at 2 months to only 20% at 1 year and even more patients had evidence of reflux esophagitis at 1 year (56 vs. 41% at inclusion). Schiefke et al [66] also reported that 18 months after EndoCinch, 80% of patients were considered treatment failures as their heartburn symptoms did not improve or PPI usage exceeded 50% of the initial dose. There were no significant changes in 24-hour esophageal pH monitoring score or LES pressure while median LES length slightly increased (3.0 to 3.2 cm; p < 0.05).…”