Endoluminal Full-Thickness Plication and Radiofrequency Treatments for GERD. An Outcomes Comparison

Arch Surg. 2009;144(1):19-24

HYPOTHESIS Endoluminal therapies have emerged as adjuncts for the treatment of gastroesophageal reflux disease (GERD) in select patients.

OBJECTIVE To compare the effectiveness of endoscopic full-thickness plication and endoscopic radiofrequency treatments for patients with GERD.

PATIENTS A total of 126 patients who underwent either endoscopic full-thickness plication (FTP) of the gastric cardia or endoscopic radiofrequency (RF) treatment of the esophagogastric junction during a 4-year period were included (68 underwent RF and 58 underwent FTP).

INTERVENTIONS: Follow-up data was obtained for 51% of patients (mean follow-up, 6 months).

MAIN OUTCOME MEASURES: Comparison of medication use, symptom scores, and pH values at baseline and follow-up.

RESULTS: In the RF group, patients with moderate to severe heartburn decreased from 55% to 22% (P=.01), and proton pump inhibitor (PPI) use decreased from 84% to 50% (P=.01). Decreases were also seen for dysphagia, voice symptoms, and cough. Percentage of time the pH was less than 4 was unchanged. In the FTP group, patients with moderate to severe heartburn decreased from 53% to 43% (P=.3), and PPI use decreased from 95% to 43% (P=.01). Percentage of time the pH was less than 4 decreased from 10.0% to 6.1% (P=.05). Decreases were also seen for regurgitation, voice symptoms, and dysphagia. There was no change in scores for chest pain or asthma in either group.

CONCLUSIONS: For patients with GERD, RF and FTP both resulted in a decrease in both PPI use and in scores for voice symptoms and dysphagia. In addition, RF resulted in decreased heartburn and cough, while FTP resulted in the most dramatic reduction in regurgitation. Our experience indicates that both procedures are effective, providing symptomatic relief and reduction in PPI use. For patients whose chief complaint is regurgitation, FTP may be the preferred procedure.