Long-term failure of endoscopic suturing in the treatment of gastroesophageal reflux:: A prospective follow-up study

Background and Study Aims: Several endoscopic antireflux therapies have been marketed, but long-term data on their objective and clinical efficacy are sparse. This report presents prospective 1-year follow-up results, including technical, clinical, and functional success rates, for the first of these treatments to be developed, endoscopic gastroplication (EGP). Patients and Methods: A total of 43 EGP procedures were carried out in 38 patients with gastroesophageal reflux disease (GERD). Two or three EndoCinch gastroplications were constructed at the level of the gastric cardia in each patient; five patients were treated twice within 6-12 months. Each endoscopic suture joined two gastric folds to each other as a double fold, known as a "gastroplication", in order to narrow the esophagogastric junction. Postprocedure data after 2 months and after 1 year were compared with preoperative data, focusing on symptoms, medication requirements, endoscopic findings, and pH-metry results. Results: In contrast to the findings at 2 months (which showed that 72% of the sutures were present and that there was a reduction in the percentage of time when the esophageal pH was < 4 from 15.4% to 8.7%), the results 1 year after EGP were considered to indicate failure of the treatment in all 38 patients because none of them still had all of the initially placed gastroplications in situ (90% of gastroplications were lost). The percentage of patients who did not require proton pump inhibitor medication decreased from 52% at 2 months to only 20% at 1 year and even more patients had evidence of reflux esophagitis at 1 year (56%) than had initially demonstrated signs of this (41%). Conclusions: EGP has some short-term beneficial effects on clinical symptoms and pH-metry. However, mainly due to the loss of the endoscopically placed sutures, these effects were not maintained at the 1-year follow-up. EGP cannot therefore be recommended for routine clinical use. Better endoscopic methods need to be developed, and they should be adequately tested before being marketed.