O0122 ENDOSCOPIC GASTROPLICATION FOR THE TREATMENT OF PAEDIATRIC GASTRO-OESOPHAGEAL REFLUX DISEASE: 12 MONTH FOLLOW UP RESULTS

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Introduction: The aim of this work is to assess the medium term efficacy of the BARD Endocinch© device for the treatment of gastro-oesophageal reflux disease (GORD) in children and adolescents. Methods: 17 (5 male) consecutive children - age 12.4 yrs (6.1–15.9), weight 46.0 kg (16.5–87.5) with symptoms of GORD dependent on PPIs for >12 months or refractory to PPIs underwent endoscopic gastroplication (EG), and follow up occurred for a median of 15 months. Symptom scoring, upper GI endoscopy, oesophageal manometry (in 4), gastric scintiscan, 24 hour oesophageal pH, and completed reflux quality of life (QOLRAD) were at 0, 6 and 52 weeks. Repeat 24 hour pH was performed at 2 (n=17) and 12 (n=9) months. Results: Median duration of the procedure for 3 plications was 65 minutes. Improvement in heartburn (p=0.001), regurgitation (p=0.002,) and nausea score (frequency ×severity) (p=0.013) was sustained at 12 months. Total, and all sub-parameters, of QOLRAD showed sustained improvement. Total QOLRAD (max 175) increased from median 101 (range 71–149) to165.6 (range 106.6–175) (p<0.0002) at 6 weeks follow up, and 153 (range 111–175) (p=0.001) 12 months. All pH parameters improved significantly. Median reflux index from 16.65% (0.9–67.9%) to 2.5% (0.7–15.7%) (p=0.001) at 6 weeks, and 4.3% (2.2–20.6) (p=0.02) at 12 months. DeMeester scores from 73 (6.1–258) to 11.95 (2.6–59.9) (normal<14.72) (p=0.002) at 6 weeks, and 19.2 (11–41.4) (p=0.018) at 12 months. 14/17 did not require any further PPI use at any stage. One patient had localized gastric bleeding requiring red cell transfusion. Conclusion: This is the first study reporting paediatric experience with an endoscopic anti-reflux procedure and demonstrates medium term sustained efficacy in managing GORD in children.

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