Harwani Y, Butala S, More B, Shukla V, Patel A. Endoscopic full-thickness plication along with argon plasma coagulation for treatment of proton pump inhibitor dependent gastroesophageal reflux disease. World J Gastrointest Endosc 2024; 16(5): 250-258 [PMID: 38813575 DOI: 10.4253/wjge.v16.i5.250]
Corresponding Author of This Article
Balaji More, MD, Associate Professor, Department of Pharmacology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry - Cuddalore Road, ECR, Pillayarkuppam, Puducherry 607402, Puducherry, India. drbdmore@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. May 16, 2024; 16(5): 250-258 Published online May 16, 2024. doi: 10.4253/wjge.v16.i5.250
Endoscopic full-thickness plication along with argon plasma coagulation for treatment of proton pump inhibitor dependent gastroesophageal reflux disease
Yogesh Harwani, Department of Gastroenterology, Nobel Gastro Hospital, Ahmedabad 408409, Gujarat, India
Shreya Butala, Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Balaji More, Department of Pharmacology, Mahatma Gandhi Medical College and Research Institute, Puducherry 607402, Puducherry, India
Varun Shukla, Anand Patel, Department of Gastroenterology, Noble Institute of Gastroenterology, Ahmedabad 380009, Gujrat, India
Author contributions: Harwani Y, Butala S, Shukla V, and Patel A contributed to involved in the collection of data and analysis; Harwani Y, Butala S, and Patel A contributed to review of the manuscript; Shukla V contributed to review of the manuscript; More B contributed to involved in the protocol preparation, analysis and writing of the manuscript.
Institutional review board statement: This is a single-center retrospective study, hence IRB approval is not required.
Informed consent statement: Regarding the informed consent form, we would like to highlight that this retrospective study did not necessitate individual patient consent due to its nature.
Conflict-of-interest statement: All authors were involved in the collection of data, analysis and writing of the manuscript.
Data sharing statement: Not available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Balaji More, MD, Associate Professor, Department of Pharmacology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry - Cuddalore Road, ECR, Pillayarkuppam, Puducherry 607402, Puducherry, India. drbdmore@gmail.com
Received: January 13, 2024 Revised: February 28, 2024 Accepted: April 25, 2024 Published online: May 16, 2024 Processing time: 121 Days and 19.5 Hours
Abstract
BACKGROUND
Most endoscopic anti-reflux interventions for gastroesophageal reflux disease (GERD) management are technically challenging to practice with inadequate data to support it utility. Therefore, this study was carried to evaluate the effectiveness and safety newer endoscopic full-thickness fundoplication (EFTP) device along with Argon Plasma Coagulation to treat individuals with GERD.
AIM
To evaluate the effectiveness and safety newer EFTP device along with Argon Plasma Coagulation to treat individuals with GERD.
METHODS
This study was a single-center comparative analysis conducted on patients treated at a Noble Institute of Gastroenterology, Ahmedabad, hospital between 2020 and 2022. The research aimed to retrospectively analyze patient data on GERD symptoms and proton pump inhibitor (PPI) dependence who underwent EFTP using the GERD-X system along with argon plasma coagulation (APC). The primary endpoint was the mean change in the total gastroesophageal reflux disease health-related quality of life (GERD-HRQL) score compared to the baseline measurement at the 3-month follow-up. Secondary endpoints encompassed enhancements in the overall GERD-HRQL score, improvements in GERD symptom scores at the 3 and changes in PPI usage at the 3 and 12-month time points.
RESULTS
In this study, patients most were in Hill Class II, and over half had ineffective esophageal motility. Following the EFTP procedure, there were significant improvements in heartburn and regurgitation scores, as well as GERD-HRQL scores (P < 0.001). PPI use significantly decreased, with 82.6% not needing PPIs or prokinetics at end of 1 year. No significant adverse events related to the procedures were observed in either group.
CONCLUSION
The EFTP along with APC procedure shows promise in addressing GERD symptoms and improving patients' quality of life, particularly for suitable candidates. Moreover, the application of a lone clip with APC yielded superior outcomes and exhibited greater cost-effectiveness.
Core Tip: The findings of this study are clinically relevant as they demonstrate that the endoscopic full-thickness fundoplication with argon plasma coagulation (APC) procedure leads to significant improvements in gastroesophageal reflux disease (GERD) symptoms and patients' quality of life, fibrosis post APC also helps in preventing suture dehiscence. The reduction in heartburn and regurgitation scores, as well as the overall gastroesophageal reflux disease health-related quality of life scores, signifies a positive impact on the subjective experience of patients with GERD. Moreover, the substantial decrease in proton pump inhibitor (PPI) usage, with a notable percentage of patients not requiring PPIs or prokinetics at 12 months, suggests a potential shift in the management paradigm towards more effective and sustainable alternatives.
