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Medium-term outcome of endoluminal gastroplication with the EndoCinch device in children
Mike Thomson1, Brice Antao, Sharon Hall
1Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, UK. mike.thomson@sch.nhs.uk
Insights
Endoluminal gastroplication (EG) effectively treats pediatric GERD, showing sustained symptom relief and improved quality of life for up to three years. This minimally invasive procedure offers a safe alternative for children dependent on medication.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
- Gastroesophageal Reflux Disease (GERD) Treatment
Background:
- Gastroesophageal reflux disease (GERD) significantly impacts children's quality of life.
- Endoluminal gastroplication (EG) is an emerging minimally invasive endoscopic technique for GERD management.
Purpose of the Study:
- To evaluate the medium-term efficacy and safety of endoluminal gastroplication (EG) in a pediatric population with GERD.
- Assess the impact of EG on symptom severity, medication dependence, and quality of life.
Main Methods:
- Seventeen pediatric patients (median age 12.4 years) with GERD underwent EG using the EndoCinch device.
- Three gastric plications were created below the lower esophageal sphincter.
- Outcomes including medication use, pH monitoring, symptom scores, and QOLRAD were compared pre-procedure and at 1 and 3 years post-procedure.
Main Results:
- Immediate improvement in symptoms and quality of life was observed in all patients.
- At 3 years, 56% of patients remained off antireflux medication, with sustained improvement in heartburn, regurgitation, and vomiting (P < 0.05).
- Total QOLRAD scores significantly improved from a median of 87 to 153.5 at 3 years (P = 0.002).
Conclusions:
- Endoluminal gastroplication (EG) is a safe and effective treatment for pediatric GERD.
- EG provides a viable therapeutic option for children with GERD refractory to or dependent on medication.
Objective:
Endoluminal gastroplication (EG) is emerging as a minimally invasive procedure for the treatment of gastroesophageal reflux disease (GERD). The aim of this study is to evaluate the medium-term outcomes after EG in a pediatric patient population.
Patients And Methods:
Seventeen children with a median age of 12.4 years (range 6.1-15.9 years) with GERD underwent EG using a flexible endoscopic sewing device (EndoCinch) over a period of 3 years. Three plications were placed in the gastric tissue below the lower esophageal sphincter. Drug dose requirement, pH measurements, symptom severity and frequency, and validated Quality of Life in Reflux and Dyspepsia (QOLRAD) scores were compared before EG and 1 and 3 years after EG. Statistical analysis was performed using a Wilcoxon rank-sum test and P < 0.05 was the threshold for significance.
Results:
All patients showed an immediate posttreatment improvement in symptom severity, symptom frequency, and quality of life scores. Completed 1- and 3-year data were obtained from 16 patients. Four cases (25%) required a repeat procedure as a result of recurrence of symptoms after 2 to 24 months. Fourteen patients (88%) at 1 year and 9 patients (56%) at 3 years remained without a need for any antireflux medication. A sustained improvement in heartburn (P = 0.004), regurgitation (P = 0.017), and vomiting (P = 0.018) was seen at 3 years. The total QOLRAD score (maximum of 175) improved from a median of 87 (range 69-142) to 156 (range 111-175) at 1 year (P < 0.0001) and 153.5 (range 55-174) at 3 years (P = 0.002).
Conclusions:
EG is an effective and safe procedure in children. It is a viable option for the treatment of GERD refractory to or dependent on antireflux medications.
