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Transoral incisionless fundoplication for treatment of gastroesophageal reflux disease in clinical practice.

Witteman BP, Strijkers R, de Vries E, Toemen L, Conchillo JM, Hameeteman W, Dagnelie PC, Koek GH, Bouvy ND - Surg Endosc (2012)

Bottom Line: Hiatal hernia was completely reduced in 56 % and esophagitis was cured in 47 % of patients.Postprocedure esophageal acid exposure did not significantly improve (p > 0.05).Quality of life scores of the remaining cohort showed significant improvement (p < 0.0001) and daily use of antisecretory medication was discontinued by 74 %.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. bplwitteman@gmail.com

ABSTRACT

Background: Transoral incisionless fundoplication is a recently introduced endoluminal technique for the treatment of gastroesophageal reflux disease (GERD). The objective of this study was to determine outcomes in chronic GERD patients who were referred for surgical management.

Methods: A cohort of 38 patients underwent transoral incisionless fundoplication (TIF) in a tertiary care setting. Pre- and post-procedure assessment included GERD-related quality of life questionnaires, proton pump inhibitor (PPI) usage, 24-h pH measurements, upper gastrointestinal endoscopy, esophageal manometry, and registration of adverse events. Duration of follow-up was 36 months.

Results: Gastroesophageal valves were constructed of 4 cm (range, 4-6) in length and 220° (range, 180-240) in circumference. One serious adverse event occurred, consisting of intraluminal bleeding at a fastener site. Hiatal hernia was completely reduced in 56 % and esophagitis was cured in 47 % of patients. Postprocedure esophageal acid exposure did not significantly improve (p > 0.05). At 36 (range, 29-41) months follow-up 14 patients (36 %) had undergone revisional laparoscopic fundoplication. Quality of life scores of the remaining cohort showed significant improvement (p < 0.0001) and daily use of antisecretory medication was discontinued by 74 %.

Conclusions: Endoluminal fundoplication improved quality of life and reduced the need for PPIs in only a subgroup of patients at 3 years follow-up. The amount of patients requiring additional medication and revisional surgery was high.

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Related in: MedlinePlus

Study timeline
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Fig1: Study timeline

Mentions: GERD-related quality of life was assessed by the GERD health-related quality of life (GERD-HRQL) questionnaire (see study timeline, Fig. 1) [23–25]. The questionnaire was developed and validated to measure changes of typical GERD symptoms, such as heartburn, in response to surgical or medical treatment. In the present study, an extended version of the questionnaire was used to assess regurgitation. A visual analogue scale ranged from 0 (no symptom) to 5 (worst symptom) and scores ≤2 were indicative of rare or absent symptoms [23, 26]. The heartburn and regurgitation scores were calculated by summing the responses to six questions referring to each symptom, and the scores ≤12 with each score ≤2 were indicative of symptom elimination. Total GERD-HRQL scores ≤30 with each score ≤2 were considered normal. Patients’ satisfaction was evaluated as satisfied, neutral, or dissatisfied [23]. Quality of life was evaluated at baseline while on antisecretory medication and at 6 and 36 months while off medication.Fig. 1


Transoral incisionless fundoplication for treatment of gastroesophageal reflux disease in clinical practice.

Witteman BP, Strijkers R, de Vries E, Toemen L, Conchillo JM, Hameeteman W, Dagnelie PC, Koek GH, Bouvy ND - Surg Endosc (2012)

Study timeline
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3472060&req=5

Fig1: Study timeline
Mentions: GERD-related quality of life was assessed by the GERD health-related quality of life (GERD-HRQL) questionnaire (see study timeline, Fig. 1) [23–25]. The questionnaire was developed and validated to measure changes of typical GERD symptoms, such as heartburn, in response to surgical or medical treatment. In the present study, an extended version of the questionnaire was used to assess regurgitation. A visual analogue scale ranged from 0 (no symptom) to 5 (worst symptom) and scores ≤2 were indicative of rare or absent symptoms [23, 26]. The heartburn and regurgitation scores were calculated by summing the responses to six questions referring to each symptom, and the scores ≤12 with each score ≤2 were indicative of symptom elimination. Total GERD-HRQL scores ≤30 with each score ≤2 were considered normal. Patients’ satisfaction was evaluated as satisfied, neutral, or dissatisfied [23]. Quality of life was evaluated at baseline while on antisecretory medication and at 6 and 36 months while off medication.Fig. 1

Bottom Line: Hiatal hernia was completely reduced in 56 % and esophagitis was cured in 47 % of patients.Postprocedure esophageal acid exposure did not significantly improve (p > 0.05).Quality of life scores of the remaining cohort showed significant improvement (p < 0.0001) and daily use of antisecretory medication was discontinued by 74 %.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. bplwitteman@gmail.com

ABSTRACT

Background: Transoral incisionless fundoplication is a recently introduced endoluminal technique for the treatment of gastroesophageal reflux disease (GERD). The objective of this study was to determine outcomes in chronic GERD patients who were referred for surgical management.

Methods: A cohort of 38 patients underwent transoral incisionless fundoplication (TIF) in a tertiary care setting. Pre- and post-procedure assessment included GERD-related quality of life questionnaires, proton pump inhibitor (PPI) usage, 24-h pH measurements, upper gastrointestinal endoscopy, esophageal manometry, and registration of adverse events. Duration of follow-up was 36 months.

Results: Gastroesophageal valves were constructed of 4 cm (range, 4-6) in length and 220° (range, 180-240) in circumference. One serious adverse event occurred, consisting of intraluminal bleeding at a fastener site. Hiatal hernia was completely reduced in 56 % and esophagitis was cured in 47 % of patients. Postprocedure esophageal acid exposure did not significantly improve (p > 0.05). At 36 (range, 29-41) months follow-up 14 patients (36 %) had undergone revisional laparoscopic fundoplication. Quality of life scores of the remaining cohort showed significant improvement (p < 0.0001) and daily use of antisecretory medication was discontinued by 74 %.

Conclusions: Endoluminal fundoplication improved quality of life and reduced the need for PPIs in only a subgroup of patients at 3 years follow-up. The amount of patients requiring additional medication and revisional surgery was high.

Show MeSH
Related in: MedlinePlus