LONG TERM OUTCOME OF ENDOLUMINAL GASTROPLICATION (ENDOCINCH) IN CHILDREN

Le résumé fourni par la source

Endoluminal gastroplication (EG) is emerging as a minimally invasive procedure for the treatment of gastroesophageal reflux disease (GORD). The aim of this study is to describe the paediatric experience and evaluate the long term outcomes after EG. Seventeen children [median age 12.4 (range 6.1-15.9) years] with GORD underwent EG using a flexible endoscopic sewing device (Endocinch) over the last 3 years. Three plications were placed in the gastric tissue below the lower oesophageal sphincter. Drug dose requirement, pH measurements, symptom severity and frequency and validated quality of life scores (QOLRAD) were compared before, one and three years after EG. Statistical analysis was done using Wilcoxon rank sum test, where p < 0.05 was considered significant. All patients showed a post-treatment improvement in symptom severity, frequency and quality of life scores. Completed 1 and 3 years data was obtained from 16 patients. Four cases required a repeat procedure due to recurrence of symptoms. Fourteen (88%) patients at one year and 9 (56%) at 3 years remained off all antireflux medications. A sustained improvement in heartburn (p = 0.004), regurgitation (p = 0.017) and vomiting (p = 0.018) was seen at 3 years. The total QOLRAD (max 175) improved from a median 87 (range 69-142) to 156 (range 111-175) at 1 year (p < 0.0001) and 153.5 (range 55-174) at 3 years (p = 0.002). The only complication was gastric bleeding in a child with undiagnosed coagulopathy, which resolved spontaneously. There is a long-term sustained subjective and objective improvement in symptoms and quality of life following EG. EG is an effective and safe procedure in children. It is a viable option for the treatment of GORD refractory to or dependent on anti-reflux medications.

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