Background: Endoluminal therapies have emerged as adjuncts for the treatment of GERD in selected patients. This analysis compares the outcomes of two different endoluminal therapies in patients with GERD.
Methods: Patients with GERD who underwent either endoscopic full-thickness plication (FTP) of the gastric cardia (NDO Plicator) or endoscopic radiofrequency (RF) treatment of the esophagogastric junction (Stretta, Curon Medical) over a four-year period were included in this study. Medication use and symptom scores for heartburn, regurgitation, dysphagia, voice symptoms, cough, chest pain, and asthma were documented at baseline and in follow-up. Statistical comparison of non-parametric values was performed using a Wilcoxon test.
Results: 127 patients were included in the study. Of these, 68 patients underwent RF and 59 patients received FTP. Follow-up data was obtained for 43% of the patients with mean follow-up of 6 months. In the RF group, patients with moderate/severe heartburn decreased from 55% to 22% (p < 0.01), and PPI use was reduced from 84% to 50% (p = 0.01). Decreases in moderate/severe scores were also seen for dysphagia (17.4% to 14.6%, p = 0.04), voice symptoms (29.8% to 14.6%, p = 0.04) and cough (32.6% to 12.2%, p = 0.01) in the RF group. In the FTP group, moderate/severe heartburn decreased from 53% to 43% (p = NS), and PPI use was reduced from 95% to 43% (p = 0.01). Decreases in moderate/severe scores were also seen for regurgitation (62.5% to 18.8%, p = 0.02), voice symptoms (35.7% to 18.8%, p = 0.01), and dysphagia (28.6% to 0%, p = 0.01) in the FTP group. There was no significant change in symptom scores for chest pain or asthma in either group. Three of the RFA patients (4.4%) and three FTP patients (5%) underwent laparoscopic Nissen fundoplication for refractory symptoms.
Conclusion: For patients with GERD, RF and FTP both resulted in a decrease in PPI use and symptom scores for voice symptoms and dysphagia. In addition, RF resulted in a decrease in heartburn and cough, while FTP had the most dramatic reduction in regurgitation. Our experience indicates that RF and FTP are both efficacious, providing symptomatic relief and reduction in PPI use. For patients whose chief complaint is regurgitation, FTP may be the preferred procedure.