Endoluminal gastroplication in children with significant gastro-oesophageal reflux disease

Abstract

Aims: To describe paediatric experience, and to assess complications and therapeutic effectiveness of the use of endoluminal gastroplication in children with gastro-oesophageal reflux disease (GORD) refractory to, or dependent on, proton pump inhibitors.

Methods: Seventeen (five male) consecutive children/adolescents (median (range) age 12.4 (6.1-15.9) years, median (range) weight 46.0 (16.5-87.5) kg) with GORD either dependent for more than 12 months on proton pump inhibitors or non-responsive to medical treatment underwent endoscopic gastroplication using a flexible endoscopic sewing device (EndoCinch). Three plications were placed in gastric tissue below the lower oesophageal sphincter. Drug dose requirement, pH measurements, daily symptom severity and frequency, and validated reflux (QOLRAD) and general gastrointestinal (GSRS) quality of life scores were compared before and after endoscopic gastroplication.

Results: All patients showed post-treatment improvement in symptom severity, frequency, and quality of life scores (p<0.0001). Three patients with recurrent symptomatic GORD had a repeat procedure within six weeks and did well subsequently. At up to 33 months of follow up (median 23), 14/17 patients remained off all antireflux medications, and 14/17 had maintained their symptomatic improvement. All pH parameters improved and had returned to normal values in 14/16 patients post-treatment and in 6/9 after one year of follow-up: in particular the reflux index had decreased from a median of 16.6% (0.9-67%) to 2.5% (0.7-15.7%) (p<0.0001) six weeks and 4.3% (2.2-20.6) (p<0.02) 12 months post-procedure. The only complication observed was gastric bleeding in one patient due to previously undiagnosed coagulopathy, which spontaneously resolved.

Conclusions: Endoluminal gastroplication is an effective and safe procedure in children/adolescents with significant GORD refractory to, or dependent on, medical anti-GORD therapy.

Figure 1

(A) Heartburn severity (/10) (pre v six weeks post, p = 0.001; pre v 12 months post, p = 0.04). (B) Heartburn index (severity×frequency in 24 hours) (pre v six weeks post, p = 0.001; pre v 12 months post, p = 0.02). (C) Regurgitation severity (/10) (pre v six weeks post, p = 0.0006; pre v 12 months post, p = 0.01). (D) Nausea frequency (per 24 hours) (pre v six weeks post, p = 0.002; pre v 12 months post, p = 0.01).

Figure 2

(a) Quality of life reflux related score (QOLRAD) (maximum, best quality, 175) (pre v six weeks post, p = 0.0002; pre v 12 months post, p = 0.0003). (B) Gastrointestinal symptom rating score (GSRS) (maximum, best, 105) (pre v six weeks post, p = 0.0008; pre v 12 months post, p = 0.002).

Figure 3

(A) pH reflux index (pre v six weeks post, p = 0.0013; pre v 12 months post, p = 0.02). (B) pH upright reflux index (pre v six weeks post, p = 0.01; pre v 12 months post, NS). (c) DeMeester pH score (pre v six weeks post, p = 0.002; pre v 12 months post, p = 0.018).