Effect of electrical stimulation therapy of the lower esophageal sphincter in GERD patients with ineffective esophageal
- PDF / 713,417 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 2 Downloads / 210 Views
and Other Interventional Techniques
Effect of electrical stimulation therapy of the lower esophageal sphincter in GERD patients with ineffective esophageal motility Matthias Paireder1 · Ivan Kristo1 · Reza Asari1 · Gerd Jomrich1 · Johannes Steindl1 · Erwin Rieder1 · Sebastian F. Schoppmann1 Received: 6 June 2020 / Accepted: 16 October 2020 © The Author(s) 2020
Abstract Background Electrical stimulation therapy (EST) of the lower esophageal sphincter (LES) is a novel technique in antireflux surgery. Due to the minimal alteration at the LES during surgery, LES-EST is meant to be ideal for patients with gastroesophageal reflux disease (GERD) and ineffective esophageal motility (IEM). The aim of this prospective trial (NCT03476265) is to evaluate health-related quality of life and esophageal acid exposure after LES-EST in patients with GERD and IEM. Methods This is a prospective non-randomized open-label study. Patients with GERD and IEM undergoing LES-EST were included. Follow-up (FUP) at 12 months after surgery included health-related quality of life (HRQL) assessment with standardized questionnaires (GERD-HRQL) and esophageal functional testing. Results According to the study protocol, 17 patients fulfilled eligibility criteria. HRQL score for heartburn and regurgitation improved from 21 (interquartile range (IQR) 15–27) to 7.5 (1.25–19), p = 0.001 and from 17 (11–23.5) to 4 (0–12), p = 0.003, respectively. There was neither significant improvement of esophageal acid exposure nor reduction of number of reflux events in pH impedance measurement. Distal contractile integral improved from 64 (11.5–301) to 115 (IQR 10–363) mmHg s cm, p = 0.249. None of the patients showed any sign of dysphagia after LES-EST. One patient needed re-do surgery and re-implantation of the LES-EST due to breaking of the lead after one year. Conclusion Although patient satisfaction improved significantly after surgery, this study fails to demonstrate normalization or significant improvement of acid exposure in the distal esophagus after LES-EST. Keywords Electrical stimulation therapy · Gastro esophageal reflux disease · Ineffective esophageal motility · Lower esophageal sphincter Antireflux surgery is recommended, if lifestyle modification and medical treatment (antacids, proton pump inhibitors (PPI), and histamine 2 (H2−) receptor antagonists) for gastroesophageal reflux disease (GERD) fail [1, 2]. Prior to surgery, manometry and pH metry are crucial tools to assess the presence of GERD and exclude esophageal motility disorders like outflow obstruction, achalasia, or other contractility disorders such as hypercontractile esophagus or absent contractility that may affect outcomes [3, 4]. Interestingly, the evolution of high-resolution manometry re-defined motility disorders like ineffective esophageal motility (IEM) * Sebastian F. Schoppmann [email protected] 1
Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria
[5]. IEM is known to be as
Data Loading...
