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Gastro-oesophageal Reflux Disease
12 months that mental and physical Short Form (SF)-36 scores were bridge therapy between pharmacological therapy and ARP, but are
significantly improved. Importantly, 80% of patients had improved unlikely to replace the existing ARP.
distal oesophageal acid exposure, as evidenced by significantly
decreased DeMeester scores (from 44 to 30; p<0.001). Moreover, Conclusion
the majority of patients (68%) were off PPIs at 12-month follow-up. GORD represents a physiological and anatomical disorder of the LOS.
A recent study evaluating the use of the NDO Plicator and Stretta The diagnostic work-up includes barium oesophagram, upper
procedure in the obese population found a significant overall failure gastrointestinal endoscopy, pH monitoring and oesophageal
rate (28%). The study demonstrated only modest reductions in manometry. To date, in selected patients surgical ARPs represent the
moderate/severe symptoms from pre-procedure evaluations. Chest standard of care. Endoluminal therapies demonstrated promising
pain and cough decreased by 4 and 14%, respectively, with larger short-term results in patients who suffer from GORD with no hiatal
decreases in voice and dysphagia complaints (25 and 23%, hernia. Further studies of the endoluminal approach are needed to
respectively). PPI use decreased from 81% pre procedure to 45% assess its safety and efficacy, especially in high-risk patients or in
post-procedure.
28
Similar to the NDO Plicator, the Esophyx also cases of recurrence after surgical repair. n
utilises the full-thickness stitch. An anterior partial fundoplication
(270º) is created by attaching the fundus to the anterior and left
Luke Martin is Administrative Chief Resident in general surgery at West Virginia University.
lateral wall of the distal oesophagus using this full-thickness suture.
He is a graduate of the Brody School of Medicine at East Carolina University in Greenville,
Two-year follow-up of 14 of the original 19 patients demonstrated North Carolina, and earned his BSc in chemistry from Guilford College in Greensboro.
no adverse events related to the procedure, relief of heartburn in
93% and elimination of daily PPI use, hiatal hernia and oesophagitis
Thomas Caranasos is a resident in the Department of Surgery at West Virginia University.
He is involved with research in the fields of trauma/critical care, cardiothoracic surgery,
in 71, 60 and 53%, respectively.
29
acute/chronic pancreatitis and minimally invasive surgery. He completed his first year of
general surgery training at the University of Southern California/LA County Hospital.
The NDO Plicator and Esophyx, as well as the other endoluminal
Ehab Akkary is Director of Minimally Invasive and
therapies, need to be evaluated very carefully in randomised
Bariatric Surgery at West Virginia University School of
studies with larger study groups and long-term comparisons. Study Medicine, where he is in the process of setting up a
groups remain small, and difficulties with recruiting patients for
single-incision laparoscopic surgery (SILS) programme. He
is an active member of the American Medical
researching the endoscopic ARPs persists. Appropriate selection
Association (AMA), the American College of Surgeons
criteria remain stringent and up to 90% of screened potential study (ACS), the American Society for Metabolic and Bariatric
participants have been excluded largely due to issues with PPI use
Surgery (ASMBS), the Society of American
Gastrointestinal Endoscopic Surgeons (SAGES) and the
and large hiatal hernias.
30
This may identify a significant difficulty in
Society of Laparoendoscopic Surgeons (SLS), among others. He completed a general
the utilisation of endoluminal therapies, as patient selection may surgery residency at North Oakland Hospital in Pontiac and his advanced fellowship
severely limit the number of potential beneficiaries of these
training at Yale University.
procedures. In all probability, they will provide an alternative or
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10 EUROPEAN GASTROENTEROLOGY & HEPATOLOGY REVIEW
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