Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(10): E1549-E1555
DOI: 10.1055/a-1535-1279
Original article

Feasibility of resection and plication “RAP” technique for management of medically refractory GERD in patients with altered gastric anatomy

Patrick R. Walsh
1   St. Vincent’s Private Hospital Northside, Chermside, Australia
2   Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia
,
Mehul Lamba
2   Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia
,
Petros Benias
3   Division of Gastroenterology, North Shore-Long Island Jewish Medical Center, Zucker school of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, New York, United States
,
Abdulnasser Lafta
2   Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia
,
George Hopkins
1   St. Vincent’s Private Hospital Northside, Chermside, Australia
2   Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background and study aims Gastroesophageal reflux disease (GERD) is common, especially in patients after gastric surgery. Medical management of GERD is ineffective in up to 30 % patients and revisional gastric surgery for management of GERD is associated with higher morbidity. We aimed to assess the safety, feasibility, and efficacy of a novel endoscopic resection and plication (RAP) anti-reflux procedure for management of medically refractory GERD in patients with altered gastric anatomy.

Patients and methods The RAP procedure involves endoscopic mucosal resection and full-thickness plication over the right posterior-medial axis extending 15 mm above and 20 to 30 mm below the squamocolumnar junction. Adverse events, technical feasibility, GERD health-related quality-of-life (GERD-HRQL) scores, and medication use were prospectively recorded.

Results Twenty consecutive patients with previous gastric surgery underwent RAP between September 2018 and August 2020 with a median follow-up of 5.7 months. The median procedure duration was 66 minutes (IQR 53.8–89.5). RAP was technically successful in 19 patients. One patient developed gastric hemorrhage from suture dehiscence, which was managed endoscopically, and four patients developed esophageal stricture requiring endoscopic dilation. Following the RAP procedure, significant improvement in GERD-HRQL score was observed (mean 26.9, 95 %CI 23.36–30.55, P < 0.01). Fourteen of 19 patients reported > 50 % improvement in GERD-HRQL scores. Sixteen of 18 patients reported reduction in requirement for or cessation of antacid therapy.

Conclusions Patients with refractory GERD after gastric surgery have limited therapeutic options. We have demonstrated that the RAP procedure is feasible, safe, and clinically effective at short-term follow-up. It provides a potential alternative to revisional surgery in patients with altered gastric anatomy.



Publication History

Received: 07 March 2021

Accepted: 16 June 2021

Article published online:
16 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2021; 53(11): 1193-1193
DOI: 10.1055/a-1543-3445

 

  • References

  • 1 Dent J, El-Serag HB, Wallander MA. et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005; 54: 710-717
    CrossrefPubMedGoogle Scholar
  • 2 Yeung KTD, Penney N, Ashrafian L. et al. Does sleeve gastrectomy expose the distal esophagus to severe reflux? a systematic review and meta-analysis. Ann Surg 2020; 271: 257-265
    CrossrefPubMedGoogle Scholar
  • 3 Inoue H, Ito H, Ikeda H. et al. Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: a pilot study. Ann Gastroenterol 2014; 27: 346-351
    PubMedGoogle Scholar
  • 4 Alvarenga ES, Lo Menzo E, Szomstein S. et al. Safety and efficacy of 1020 consecutive laparoscopic sleeve gastrectomies performed as a primary treatment modality for morbid obesity. A single-center experience from the metabolic and bariatric surgical accreditation quality and improvement program. Surg Endosc 2016; 30: 2673-2678
    CrossrefPubMedGoogle Scholar
  • 5 Scarpellini E, Ang D, Pauwels A. et al. Management of refractory typical GERD symptoms. Nat Rev Gastroenterol Hepatol 2016; 13: 281-294
    CrossrefPubMedGoogle Scholar
  • 6 McCarty TR, Itidiare M, Njei B. et al. Efficacy of transoral incisionless fundoplication for refractory gastroesophageal reflux disease: a systematic review and meta-analysis. Endoscopy 2018; 50: 708-725
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Hunter JG, Kahrilas PJ, Bell RC. et al. Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology 2015; 148: 324-33 e5
    CrossrefPubMedGoogle Scholar
  • 8 Hakansson B, Montgomery M, Cadiere GB. et al. Randomised clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD. Aliment Pharmacol Ther 2015; 42: 1261-1270
    CrossrefPubMedGoogle Scholar
  • 9 Weitzendorfer M, Spaun GO, Antoniou SA. et al. Clinical feasibility of a new full-thickness endoscopic plication device (GERDx) for patients with GERD: results of a prospective trial. Surg Endosc 2018; 32: 2541-2549
    CrossrefPubMedGoogle Scholar
  • 10 Zacherl J, Roy-Shapira A, Bonavina L. et al. Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler (MUSE) for gastroesophageal reflux disease: 6-month results from a multi-center prospective trial. Surg Endosc 2015; 29: 220-229
    CrossrefPubMedGoogle Scholar
  • 11 Kim HJ, Kwon CI, Kessler WR. et al. Long-term follow-up results of endoscopic treatment of gastroesophageal reflux disease with the MUSE endoscopic stapling device. Surg Endosc 2016; 30: 3402-3408
    CrossrefPubMedGoogle Scholar
  • 12 Roy-Shapira A, Bapaye A, Date S. et al. Trans-oral anterior fundoplication: 5-year follow-up of pilot study. Surg Endosc 2015; 29: 3717-3721
    CrossrefPubMedGoogle Scholar
  • 13 Perry KA, Banerjee A, Melvin WS. Radiofrequency energy delivery to the lower esophageal sphincter reduces esophageal acid exposure and improves GERD symptoms: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 2012; 22: 283-288
    CrossrefPubMedGoogle Scholar
  • 14 Corley DA, Katz P, Wo JM. et al. Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial. Gastroenterology 2003; 125: 668-6676
    CrossrefPubMedGoogle Scholar
  • 15 Fass R, Cahn F, Scotti DJ. et al. Systematic review and meta-analysis of controlled and prospective cohort efficacy studies of endoscopic radiofrequency for treatment of gastroesophageal reflux disease. Surg Endosc 2017; 31: 4865-4882
    CrossrefPubMedGoogle Scholar
  • 16 Lipka S, Kumar A, Richter JE. No evidence for efficacy of radiofrequency ablation for treatment of gastroesophageal reflux disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2015; 13: 1058-1067 e1
    CrossrefPubMedGoogle Scholar
  • 17 Triadafilopoulos G. Stretta: a valuable endoscopic treatment modality for gastroesophageal reflux disease. World J Gastroenterol 2014; 20: 7730-7738
    CrossrefPubMedGoogle Scholar
  • 18 Benias PC, D'Souza L, Lan G. et al. Initial experience with a novel resection and plication (RAP) method for acid reflux: a pilot study. Endosc Int Open 2018; 6: E443-E449
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Raphael KL, Walsh P, Benias PC. Innovations in endoscopic therapy for gastroesophageal reflux disease. Gastrointest Endosc Clin N Am 2020; 30: 291-307
    CrossrefPubMedGoogle Scholar
  • 20 Velanovich V, Vallance SR, Gusz JR. et al. Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 1996; 183: 217-224
    PubMedGoogle Scholar
  • 21 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedGoogle Scholar
  • 22 Kirchheiner J, Glatt S, Fuhr U. et al. Relative potency of proton-pump inhibitors-comparison of effects on intragastric pH. Eur J Clin Pharmacol 2009; 65: 19-31
    CrossrefPubMedGoogle Scholar
  • 23 te Riele WW, Sze YK, Wiezer MJ. et al. Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients. Surg Obes Relat Dis 2008; 4: 735-739
    CrossrefPubMedGoogle Scholar
  • 24 Roller JE, Provost DA. Revision of failed gastric restrictive operations to Roux-en-Y gastric bypass: impact of multiple prior bariatric operations on outcome. Obes Surg 2006; 16: 865-869
    CrossrefPubMedGoogle Scholar
  • 25 Stefanidis D, Malireddy K, Kuwada T. et al. Revisional bariatric surgery: perioperative morbidity is determined by type of procedure. Surg Endosc 2013; 27: 4504-4510
    CrossrefPubMedGoogle Scholar
  • 26 Khoursheed MA, Al-Bader IA, Al-asfar FS. et al. Revision of failed bariatric procedures to Roux-en-Y gastric bypass (RYGB). Obes Surg 2011; 21: 1157-1160
    CrossrefPubMedGoogle Scholar
  • 27 Monino L, Gonzalez JM, Vitton V. et al. Antireflux mucosectomy band in treatment of refractory gastroesophageal reflux disease: a pilot study for safety, feasibility and symptom control. Endosc Int Open 2020; 8: E147-E154
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Debourdeau A, Vitton V, Monino L. et al. Antireflux mucosectomy band (ARM-b) in treatment of refractory gastroesophageal reflux disease after bariatric surgery. Obes Surg 2020; 30: 4654-4658
    CrossrefPubMedGoogle Scholar
  • 29 Patil G, Dalal A, Maydeo A. Feasibility and outcomes of anti-reflux mucosectomy for proton pump inhibitor dependent gastroesophageal reflux disease: First Indian study (with video). Dig Endosc 2020; 32: 745-752
    CrossrefPubMedGoogle Scholar
  • 30 Ponce J, DeMaria EJ, Nguyen NT. et al. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis 2016; 12: 1637-1639
    CrossrefPubMedGoogle Scholar
  • 31 Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013; 23: 427-436
    CrossrefPubMedGoogle Scholar
  • 32 Mahawar KK, Carr WR, Jennings N. et al. Simultaneous sleeve gastrectomy and hiatus hernia repair: a systematic review. Obes Surg 2015; 25: 159-166
    CrossrefPubMedGoogle Scholar