Full-thickness Gastroplication for the Treatment of Gastroesophageal Reflux Disease: Short-term Results of a Feasibility Clinical Trial
*Department of General Surgery †Division of Clinical Psychology, General Hospital Zell am See, Zell am See, Austria.Surgical laparoscopy, endoscopy & percutaneous techniques (Impact Factor: 1.14). 12/2012; 22(6):503-8. DOI: 10.1097/SLE.0b013e318265af1f
This was a prospective study that evaluates subjective and objective patient parameters 3 months after full-thickness gastroplication. Forty-one patients with documented gastroesophageal reflux disease and persistent symptoms despite medical treatment, without radiologic visible hiatal hernia, were enrolled in the study and underwent endoscopic full-thickness gastroplication with one or more plicator implants. Evaluation of Gastrointestinal Quality of Life Index, symptoms typically related to reflux, gas bloat, and bowel dysfunction and esophageal manometry, and impedance-pH monitoring were performed at baseline and 3 months after the procedure. The mean Gastrointestinal Quality of Life Index score, and general and reflux-specific scores improved significantly (P<0.01), and gas bloat-specific symptom scores and bowel dysfunction-specific symptom scores were reduced (P<0.05) on follow-up. The numbers of total, acid, proximal, upright, and recumbent reflux episodes were all reduced (P<0.01). Manometric data remained almost unchanged. DeMeester score reduced nonsignificantly (P<0.098). 21.6% of the patients were on proton-pump inhibitor medication on a daily basis after the procedure. There was only 1 postprocedure incident (bleeding) that required intervention. In conclusion, endoscopic full-thickness plication is a safe and well-tolerated procedure that significantly improves quality of life and eliminates gastroesophageal reflux disease symptoms in the majority of patients, without side effects seen after laparoscopic fundoplication.
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ABSTRACT: Introduction: in elderly Gastro-Esophageal Reflux Disease (GERD) is very common among gastrointestinal diseases, unusually more severe than young patients frameworks, and frequently under-diagnosed. Here we conducted a retrospective study of our endoscopic series in order to assess the prevalence and clinical characteristics of GERD in the elderly. Materials and methods: we retrospectively studied patients underwent esophagogastroduodenoscopy (EGD) with symptoms referred to the upper gastrointestinal tract (heartburn, chest pain, dysphagia, regurgitation, and dyspepsia) and/or anemia of unknown origin. Results: 3663 patients with GERD-related symptoms/signs underwent EGD, 2594 aged <65 years old (GROUP A), with male/female (M/F) ratio 1.73 (1645 males vs. 949 females), and 1069 aged = 65 years old (GROUP B), with M/F ratio 1.34 (613 males vs. 456 females). Esophagitis diagnosis was made on 2549 patients, 1815 were aged <65 years old and 734 aged = 65 years old. Elderly showed more frequently severe esophagitis (6% vs. 11%), association with hiatal hernia (45% vs. 74%) and duodenal ulcer (4% vs. 20%), dysphagia (2% vs. 6%), dyspepsia (7% vs. 14%) and anemia (1% vs. 6%) compared to GROUP A, while among the younger patients regurgitation (33% vs. 24%) and chest pain (16% vs. 11%) were more frequent compared to GROUP B. Heartburn had a frequency similar between the two groups (39% vs. 40%). As regards the effectiveness of acute therapy and longterm treatment, PPIs showed the highest rates of healing and remission of symptoms, respectively, without differences between elderly and younger patients. Discussion: our results confirmed literature data, and underlined the importance to consider this disease in these patients, at high risk because of comorbidities and polypharmacy. After EGD, severe esophagitis was found more frequently in elderly, as well as the association with other diseases, such as hiatal hernia or duodenal ulcer.
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ABSTRACT: Analyzing medical issues related to the elderly patients, particularly in the gastroenterological sphere, Gastro-Esophageal Reflux Disease (GERD) seems to be a disease that reaches an important role in terms of diagnosis and therapy, as well as adversely affect the quality of life of these "frail" patients. Comorbidities that affect these patients often lead to reduce the importance of this disease, which in fact, not infrequently, it is difficult to identify because of mild symptom picture compared to younger patients. Is important to remember that GERD, although in most cases provokes only vague dyspeptic symptoms, can also lead to serious complications, such as bleeding especially in patients with impaired hemostasis, aspiration pneumonia, or even to cancerization of Barrett's esophagus. In addition, there are several factors favoring GERD, for example polypharmacy carried out for other conditions, which can modify the physiology of the anti-reflux mechanisms. This review addresses the problem of GERD, analyzing it in all its aspects.
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ABSTRACT: Flexible endoscopy is increasingly developing into a therapeutic instead of a purely diagnostic discipline. Improved visualization makes early lesions easily detectable and allows us to decide ad hoc on the required treatment. Deep enteroscopy allows the exploration of even the small bowel - for long a "white spot" for gastrointestinal endoscopy - and to perform direct treatment. Endoscopic submucosal dissection is a considerable step forward in oncologically correct endoscopic treatment of (early) malignant lesions. Though still technically challenging, it is increasingly facilitated by new manipulation techniques and tools that are being steadily optimized. Closure of wall defects and hemostasis could be improved significantly. Even the anatomy beyond the gastrointestinal wall is being explored by the therapeutic use of endoluminal ultrasound. Endosonographic-guided surgery is not only a suitable fallback solution if conventional endoscopic retrograde cholangiopancreatography fails, but even makes necrosectomy procedures, abscess drainage, and neurolysis feasible for the endoscopist. Newly developed endoscopic approaches aim at formerly distinctive surgical domains like gastroesophageal reflux disease, appendicitis, and cholecystitis. Combined endoscopic/laparoscopic interventional techniques could become the harbingers of natural orifice transluminal endoscopic surgery, whereas pure natural orifice transluminal endoscopic surgery is currently still in its beginnings.
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