Background: Endoscopic fundoplication is a new technique in the treatment of gastroesophageal reflux disease (GERD). Despite preliminary reports of early success, there are no studies comparing it to laparoscopic antireflux surgery. The purpose of this study is to compare early symptomatic improvements of these two procedures.
Methods: After an initially learning period, 27 patients underwent endoscopic fundoplication. All had symptoms of GERD, upper endoscopy, esophageal manometry and 24 hr pH monitoring consistent with pathologic reflux. Endoscopic fundoplication was accomplished using BARD" instrumentation. All patients preprocedure completed a symptom severity questionnaire (best score 0, worst score 50). Patients completed the questionnaire about 6 weeks postprocedure. These 27 patients were then matched by age, gender and preprocedure symptom score to patients in a prospectively gathered data base of laparoscopic antireflux cases (either Nissen or Toupet fundoplications). Data were analyzed using the paired Sign-Test, paired t-test, or chi-squared test.
Results: 21 patients (78%) in the endoscopic fundoplication groups were satisfied with their symptomatic outcome, 2 (7%) were neutral, and 4 (15%) dissatisfied. This compares to 26 (96%) satisfied patients in the laparoscopic group (p<0.01). Nevertheless, median symptom scores decreased similarly in both groups: endoscopic group preprocedure median score 30 (range 16) to postprocedure score 2 (range 26)(p<0.01); laparoscopic group 29 (range 21) to 2 (range 15) (p<0.01). There was no statistically significant difference in the postprocedure scores between the two groups. The patients who were dissatisfied had an mean drop in symptom score of 10 compared to 27 for satisfied patients (p<0.01).
Conclusion: Endoscopic fundoplication is a viable alternative to laparoscopic fundoplication in selected patients. These short-term follow-up results suggest equivalent symptomatic improvement. Approximately one-quarter of patients will have no improvement, and this is higher compared to laparoscopic fundoplication. A randomized controlled trial with longer follow-up is required.
