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Initial experience with a novel resection and plication (RAP) method for acid reflux: a pilot study.

Petros C Benias1, Lionel D'Souza2, Gloria Lan2

  • 1Zucker School of Medicine at Hofstra/Northwell.

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Summary

A novel resection and plication (RAP) procedure shows promise for treating gastroesophageal reflux disorder (GERD). This minimally invasive anti-reflux therapy significantly improved patient quality of life and reduced medication dependence.

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Area of Science:

  • Gastroenterology
  • Minimally Invasive Surgery
  • Endoscopic Therapeutics

Background:

  • Gastroesophageal reflux disorder (GERD) treatments often face challenges with technical complexity and cost.
  • Existing endoscopic therapies for GERD may not be universally accessible or effective.
  • Proton pump inhibitor (PPI) therapy is a common treatment, but some patients remain refractory.

Purpose of the Study:

  • To evaluate the efficacy and safety of a novel resection and plication (RAP) anti-reflux procedure.
  • To assess the impact of RAP on patient-reported outcomes and medication use.
  • To determine the feasibility of RAP as an alternative endoscopic therapy for GERD.

Main Methods:

  • The resection and plication (RAP) procedure was performed on 10 patients with PPI-refractory GERD.
  • RAP involves semi-circumferential mucosectomy and full-thickness plication of the lower esophageal sphincter (LES) and cardia.
  • Outcomes assessed included technical success, safety, GERD-Health Related Quality of Life (GERD-HRQL) scores, and medication usage.

Main Results:

  • All 10 patients tolerated the RAP procedure well, with no adverse events, and were discharged the same day.
  • Significant improvement in GERD-HRQL scores was observed in all patients (P < .0001).
  • Eight out of ten patients eliminated their daily PPI dependence, and only half required general anesthesia.

Conclusions:

  • The resection and plication (RAP) method demonstrates potential as an effective anti-reflux treatment.
  • Key advantages of RAP include a short procedure time, a simple approach, and the potential to avoid general anesthesia.
  • RAP offers a promising, accessible endoscopic option for managing refractory GERD.