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. 2003 Jan;52(1):34-9.
doi: 10.1136/gut.52.1.34.

Endocinch therapy for gastro-oesophageal reflux disease: a one year prospective follow up

Z Mahmood  1 , B P McMahon, Q Arfin, P J Byrne, J V Reynolds, E M Murphy, D G Weir
Affiliations

Endocinch therapy for gastro-oesophageal reflux disease: a one year prospective follow up

Z Mahmood et al. Gut. 2003 Jan.

Abstract

Background: Gastro-oesophageal reflux disease (GORD) is, in the main, treated with either proton pump inhibitor (PPI) drugs or a Nissen fundoplication operation. Recently, BARD developed Endocinch, a device used to place sutures just below the oesophagogastric junction (OGJ) to treat GORD.

Aim: To evaluate the long term benefit of the Endocinch technique in patients seen up to 12 months post procedure.

Patients: Twenty six patients with symptoms of GORD were recruited and had the procedure performed. Four patients were lost to follow up.

Methods: Twenty two patients completed their one year follow up. Pre procedure and post procedure (up to 12 months) assessments included symptom scoring (DeMeester), upper intestinal endoscopy, oesophageal manometry and 24 hour oesophageal pH, and completion of quality of life (QOL) questionnaires.

Results: Mean age was 39 years (range 22-62). Heartburn symptom score was reduced from a mean value of 19.22 at baseline to 7.5 at 12 months (n=22) (p<0.0001). Regurgitation score reduced from a mean of 2.27 at baseline to 0.86 at 12 months (n=22) (p<0.001). Mean (SEM) pH DeMeester acid score was reduced from 44.1 (4.3) to 33.32 (4.73) (p=0.028) at three month post procedure. Percentage upright acid exposure and number of reflux episodes were also reduced significantly. Use of PPIs was reduced by 64% at 12 months post procedure. All QOL assessments showed significant improvement (p=0.01). All transient post procedure complaints resolved within 72 hours.

Conclusion: The Endocinch procedure is an effective and safe outpatient procedure that offers GORD patients significant improvement in symptomatology, QOL, and reduced requirements for PPIs over at least a one year period.

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Figures

Figure 1
Figure 1
Symptom scoring of the patient data set, normalised to percentage, before (baseline) and one, three, six, and 12 months post procedure, where a maximum symptom score of 30 is represented as 100%. The horizontal lines of the box denote the 25th, 50th, and 75th percentile values, where the 50th percentile is the median of the range of the data. The square symbol in the box denotes the mean. Error bars denote the 5th and 95th percentiles and asterisks the 0 and 100th percentiles.
Figure 2
Figure 2
Regurgitation score before (baseline) and one, three, six, and 12 months post procedure. Data are normalised to percentage where a maximum regurgitation score of 3 (that is, severe, daily) is represented as 100%. The square symbol represents the mean and the error bars the SD of the mean.
Figure 3
Figure 3
Combined results of the five parameters of quality of life (QOL) assessment before (baseline) and one, three, six, and 12 months post procedure. Data are normalised to percentage where a maximum symptom score of 175 (that is, normality) is represented as 100%. Boxes and symbols as for fig 1 ▶.
Figure 4
Figure 4
Patient requirements for proton pump inhibitors (PPIs) before (baseline) and one, three, six, and 12 months post procedure (patient off medication was defined as if requiring less than four doses a month).
Figure 5
Figure 5
Symptom scores at six and 12 months, and DeMeester scores at three months post procedure in all patients, in patients who reverted back to proton pump inhibitor (PPI) therapy, and in those who remained off PPIs. †One patient failed to attend for follow up 24 hour oesophageal pH but remained off PPIs at 12 months post procedure. Boxes for symbols as for fig 1 ▶.
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Comment in

  • [Endoscopic reflux therapy by Endocinch].
    Bittinger M, Messmann H. Bittinger M, et al. Z Gastroenterol. 2003 Feb;41(2):204-6. doi: 10.1055/s-2003-37311. Z Gastroenterol. 2003. PMID: 16308927 German. No abstract available.

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