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Trends in Utilization of Surgical and Endoscopic Anti-Reflux Procedures in the United States (1995-2024)
Daniel Martin Simadibrata1, Ofer Zvi Fass2, Ronnie Fass3
1Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
Objective:
Growing concerns about the adverse effects of long-term proton pump inhibitor use may have renewed interest in alternative treatments for gastroesophageal reflux disease (GERD), including surgical and endoscopic interventions. This study evaluated utilization trends of anti-reflux surgical and endoscopic procedures in the United States between 1995 and 2024.
Methods:
A population-based analysis was conducted using TriNetX, a database comprising 70 US healthcare organizations. GERD patients (erosive esophagitis, non-erosive reflux disease, and Barrett's esophagus) were identified. Annual incidence rates per 100,000 GERD patients were calculated for surgical fundoplication, magnetic sphincter augmentation (LINX), endoscopic radiofrequency therapy (Stretta), and endoscopic fundoplication. Joinpoint regression analysis determined annual percentage changes (APCs) and 95% confidence intervals (95% CIs). Interrupted time-series analysis assessed associations between major regulatory/clinical events and utilization trends.
Results:
Utilization of surgical fundoplication declined from 2000 to 2007 (APC -14.94%; 95% CI -25.04% to -8.69%; p = 0.002) but increased from 2007 to 2017 (APC +33.00%; 95% CI +27.15% to +59.60%; p < 0.001) and through 2024 (APC +9.04%; 95% CI -6.52% to +16.86%; p = 0.126), reaching 135.89 cases per 100,000 GERD patients. LINX saw rapid utilization starting in 2016 (APC +411.68%; 95% CI +83.91% to +921.59%; p < 0.001) but decreased after 2018 (APC -28.20%; 95% CI -52.16% to -12.40%; p = 0.002). Stretta initially increased but later plateaued (APC +40.76%; 95% CI -17.26% to +137.41%; p = 0.195). Conversely, endoscopic fundoplication demonstrated consistent growth through 2024 (APC +13.25%; 95% CI +3.91% to +23.44%; p = 0.011).
Conclusions:
Despite an early decline, surgical fundoplication utilization has increased over the past two decades. Endoscopic fundoplication continues to rise, while LINX and Stretta have declined over the past 7 years.
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