Endoluminal therapies for the treatment of gastroesophageal reflux disease (GERD) are gaining increased attention. Due to technical limitations, patients must be highly selected for this approach. Current practice excludes patients with hiatal hernia >2cm, Barrett s esophagus, dysphagia, esophageal strictures, or esophagitis >grade 2. Long-term follow up after endoluminal therapy is not available. However, in a recent study, at 3 months, only 2/3rds of patients reported successful outcomes. In the present study, we assessed outcome of LARS in patients eligible for an endoluminal approach. 410 consecutive patients undergoing LARS were prospectively entered into an ongoing database over a 7 year period. Of these, 116 (28%) met the inclusion criteria listed above. Mean (±SD) age was 44±9 yrs (range 18-71). Operative time was 116±39 min. Post operative LOS was 1.0±1.0 days, and return to work occurred by 12±5 days. Short-term complications were noted in 3 patients (3%). Three patients (3%) required reoperation for failure. Symptoms and acid-reduction medication use were assessed preoperatively, and at 1 month, and 1, 2, and 4 years postoperatively. Significant and durable symptom improvement was noted compared to preop (see table). LARS was found to be efficacious in providing relief of GERD symptoms in >90% of patients. In addition, symptom relief was durable, out to four years of follow up. These results are significantly better than those reported for endoluminal therapies, even in this most favorable group of GERD patients.
Percentage of patients reporting medication use or symptoms over time
Medication Use Heartburn Regurgitation Chest Pain
preoperative 100% 87% 81% 44%
one month 10%* 5%* 4%* 9%*
one year 11%* 7%* 5%* 7%*
two years 7%* 5%* 5%* 5%*
four years 7%* 7%* 7%* 7%*
*p<0.001 to preop
