Endoscopic therapies of gastroesophageal reflux disease

Table 1 Endotherapy result comparisons: pooled data

Trial result	ELGP	NDO Plicator	Stretta	Enteryx	Gatekeeper1
HDQRL improvement	55%	70%	65%	70%	74%1
Heartburn improvement	74%	-	61%	71%	-
Off PPI’s
At 1 yr	40%	75%	55%	72%	58%1
At > 2 yr	33%	-	63%	65%	-
≥ 50% reduction in PPI	51%	-	67%	80%	54%1
Quality of life improvement
SF-36 Physical	17%	31%	20%	12%	17%1
SF-36 Mental	None	10%	14%	3%	1.4%1
Time pH < 4 improvement	16%	None	36%	33%	32%1
No. of reflux episode improvement	33%	-	None	31%	45%1
pH normalization	25%	-	-	38%	40%1
LESP improvement	None	None	None	None	None
LES length improvement	None	None	None	None	None
tLESR improvement	Yes	No	Yes	No	No
Healing of esophagitis	None	None	None	None	None
Sham Trial	3-mo FU	Being planned	1-yr FU	Underway	Underway

¹6 mo follow-up. None: Change not statistically significant. All results are at 1-yr follow-up except Gatekeeper. Highlighted cell indicate controversy regarding results but the results mentioned above are the ones shown by the majority of studies.

Table 2 Procedure characteristics and complications: Pooled data

Variable		Endocinch	NDO Plicator	Stretta	Enteryx	Gatekeeper
Procedure duration (mean)		68 min	20 min	69 min	33 min	35-60 min
Personnel required		1 physician and 2 assistants	1 physician and 2 assistants	1 physician and 2 assistants	1 physician and 2 assistants	1 physician and 2-3 assistants
Sedation required		Conscious sedation 82%	NA	Conscious sedation 100%	Conscious sedation 100%	NA
Approximate no. of procedures performed		4000	NA	4000	2600	225
Major complication	Perforation	0.08%	0.00%	0.13%	0%	0.40%
	Bleeding	0.05%	NA	0.05%	0%	0%
	Hypoxemia	0.08%	0%	0%	0%	0%
	Pleural effusion	0%	0%	0.03%	0.08%	0%
	Pericardial effusion	0%	0%	0%	0.08%	0%
	Aspiration pneumonia	0%	0%	0.05%	0%	0%
	Esophageal abscess	0%	0%	0%	0.04%	0%
	Ulceration over prostheses	0%	0%	0%	0%	0.40%
	Death	0%	0%	0.05%	0.04%	0%
Minor complications		• Sore throat(0.35%)	-	• Superficial mucosal injury	• Garlic odor for several hours(due to DMSO)	• Sore throat (15%)
		•Chest soreness(0.17%)		• Burn at pad site (0.02%)		• Chest pain (5%)
		• Abdominal pain(0.15%)		• Transient A. fib (0.02%)		• Nausea/ vomiting(0.8%)
					• Chest pain (82%)
		• Bloating(0.02%)		• Bloating (0.02%)		• Erosive duodenitis(0.8%)
					• Transient dysphagia(13%)
				• Gastroparesis and ulcerative esophagitis (0.02%)		• Retrosternal pain (0.4%)
		• Transient dysphagia (0.05%)
					• Belching/ burping	• Poor sleep (0.4%)
				• Low grade fever	• Bloating/ flatulence	• Abdominal pain (0.4%)
		• Bronchospasm(0.01%)		• Transient dysphagia	• Fever
				• Transient chest pain		• Rash (0.4%)
				• Topical anesthesia-related complications(eg. Allergy, hypotension)		• Cough (0.4%)

NA: not available.