OESOPHAGUS

Endoluminal gastroplication in children with significant gastro-oesophageal reflux disease

M Thomson¹, A Fritscher-Ravens², S Hall¹, N Afzal¹, P Ashwood¹, C P Swain²

¹ Centre for Paediatric Gastroenterology, Royal Free Hospital NHS Trust, London, UK
² Royal London and St Bartholomew’s Hospitals NHS Trust, London, UK

Correspondence to:
Correspondence to:
Dr M Thomson
Centre for Paediatric Gastroenterology, Sheffield Children’s Hospital, Western Bank, Sheffield S10 2TH, UK; mike.thomson{at}sch.nhs.uk

Aims: To describe paediatric experience, and to assess complications and therapeutic effectiveness of the use of endoluminal gastroplication in children with gastro-oesophageal reflux disease (GORD) refractory to, or dependent on, proton pump inhibitors.

Methods: Seventeen (five male) consecutive children/adolescents (median (range) age 12.4 (6.1–15.9) years, median (range) weight 46.0 (16.5–87.5) kg) with GORD either dependent for more than 12 months on proton pump inhibitors or non-responsive to medical treatment underwent endoscopic gastroplication using a flexible endoscopic sewing device (EndoCinch). Three plications were placed in gastric tissue below the lower oesophageal sphincter. Drug dose requirement, pH measurements, daily symptom severity and frequency, and validated reflux (QOLRAD) and general gastrointestinal (GSRS) quality of life scores were compared before and after endoscopic gastroplication.

Results: All patients showed post-treatment improvement in symptom severity, frequency, and quality of life scores (p<0.0001). Three patients with recurrent symptomatic GORD had a repeat procedure within six weeks and did well subsequently. At up to 33 months of follow up (median 23), 14/17 patients remained off all antireflux medications, and 14/17 had maintained their symptomatic improvement. All pH parameters improved and had returned to normal values in 14/16 patients post-treatment and in 6/9 after one year of follow-up: in particular the reflux index had decreased from a median of 16.6% (0.9–67%) to 2.5% (0.7–15.7%) (p<0.0001) six weeks and 4.3% (2.2–20.6) (p<0.02) 12 months post-procedure. The only complication observed was gastric bleeding in one patient due to previously undiagnosed coagulopathy, which spontaneously resolved.

Conclusions: Endoluminal gastroplication is an effective and safe procedure in children/adolescents with significant GORD refractory to, or dependent on, medical anti-GORD therapy.

Abbreviations: GORD, gastro-oesophageal reflux disease; EG, endoluminal gastroplication; QOLRAD, quality of life rating score; GSRS, gastrointestinal symptom rating score; GOJ, gastro-oesophageal junction

Keywords: gastro-oesophageal reflux; surgery; endoscopic fundoplication; children

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