Peroral Endoscopic Cardial Constriction with Band Ligation for Gastroesophageal Reflux Disease: A Prospective Pilot...

Background Limited retrospective data suggest peroral endoscopic cardial constriction with band ligation (PECC-b) as a feasible, safe, and effective treatment for GERD. We performed a prospective study to assess the efficacy and safety of PECC-b for the treatment of GERD. Methods We prospectively recruited proton pump inhibitor (PPI)-dependent GERD patients. Patients with absence of acid reflux on a 24-hour pH study, esophageal motility disorder, and ≥Hill's grade III hiatus on endoscopy were excluded. The primary endpoint was GERD health-related quality of life (GERD-HRQL) score improvement at 3 months. Secondary end points were decrease in PPI use, esophageal acid exposure time, reflux episodes, and DeMeester score at 3 months. Safety outcomes included serious and overall adverse events. Results Between July 2023 and June 2025, 130 patients were screened. Of these, 40 patients underwent PECC-b therapy (median age 34 years (IQR: 18-60), 75% male) and were followed up for 3 months. At follow-up, significant improvement in GERD-HRQL scores (22.8 ± 3.2 at baseline to 12 ± 4.7; p < 0.001) was observed. In total, 85% ( n = 34) of the patients achieved complete or partial PPI independence at 3 months. Median acid exposure time decreased from 28.1% (IQR: 18.2-54.5%) to 14.8% (8.0-18.0%) ( p < 0.05), median number of reflux episodes from 81.5 (53.8-126) to 30 (21.8-70.8) ( p < 0.005), and the Demeester score decreased from 103 (51-161) to 52.5(33.5-78.3) ( p < 0.005). Totally, 15 (37%) patients had chest pain postprocedure and required analgesics. There were no serious procedure-related adverse events. Conclusion PECC-b is a promising, safe, and effective endoscopic treatment for PPI-dependent GERD, offering significant symptomatic relief and improvement in quality of life.