Comparative results of endoluminal gastroplasty and laparoscopic antireflux surgery for the treatment of GERD

Background: Transoral endoluminal gastroplasty (EG) by the Bard Endocinch device is available for the treatment of gastroesophageal reflux disease (GERD). This study assessed the early (less than or equal to12 months) outcomes in patients undergoing EG performed by one gastroenterologist compared with another set of patients referred by the same gastroenterologist for laparoscopic antireflux surgery (LAS) at a foregut surgery center. Methods: From June 2000 to July 2002, 87 consecutive patients cared for by a single gastroenterologist were diagnosed with refractory GERD and underwent either EG (n = 47) or referral for LAS (n = 40). Preoperative evaluation included symptom assessment, pH studies, and motility studies. Outcomes were assessed by symptomatic improvement and dependence on anti-acid medications. Data analyzed by chi-square or Mann-Whitney tests are reported as mean +/- SEM. Results: Preoperative symptom duration, Johnson-DeMeester (JD) score, % time pH < 4, and reflux episodes were statistically similar in both treatment groups. The follow-up times for EG and LAS groups were 7.3 +/- 0.9 and 8 +/- 0.4 months, respectively. Of EG patients, 94% were available for follow-up, and all LAS patients had follow-up data. Overall, 66% of patients were satisfied with EG as compared to 93% after LAS (p = 0.1). Postoperative PPI/motility agent use was 32% for EG and 13% for LAS (p = 0.03). Identifiable causes of EG failure were premature procedure termination due to hypoxia or bleeding (three patients), intractable vomiting (two patients), and delayed gastric emptying (five patients). Three EG patients subsequently had LAS within 6 months of the procedure. Conclusions: LAS offers greater reduction in medication use than EG, as well as more durable patient satisfaction. Benefits of EG may include short-term symptomatic improvement while considering definitive surgical management.