Endoluminal gastroplication (ELGP) is a new treatment for chronic gastroesophageal reflux disease (GERD), which combines endoscoy and the Bard® EndoCinch™ Suturing System. The procedure can be performed on an outpatient basis under sedation, making it a much more convenient and cost-effective treatment than open chest surgery or long-term drug therapy. Endoluminal gastroplication reduces the procedure time and recovery time dramatically, and reduces the risk of complications. The results in terms of reduction of acid reflux are very positive. ELGP has been shown to significantly improve regurgitation and heartburn, as well as eliminate the need for commonly prescribed drugs, such as Prilosec and Prevacid.

Equipment
Endoluminal gastroplication requires two video endoscopes, an esophageal overtube, and the EndoCinch Suturing System. The treatment is administered by an experienced therapeutic endoscopist and assistant.

Reasons for the Exam

The ELGP procedure is an innovative minimally-invasive alternative to the open chest surgery called Nissen Fundoplication in the treatment of GERD. The clinical benefits and cost savings associated with ELGP when compared to the outcomes and expense associated with chronic anti-secretory drug therapy and Nissen surgery makes this outpatient procedure the preferred course of action for many patients. Patients who experience reflux disease symptoms characterized by heartburn and regurgitation who do not want to consider invasive surgery or expensive long-term drug therapy may be candidates for ELGP.

Preparation

Patients should consult with their physician regarding preparation for the endoluminal gastroplication procedure. Generally this will involve not taking any food or liquids for several hours prior to the procedure. Because the procedure is performed under sedation, patients should also inform their physician of any drugs they are taking which may effect the function of the esophagus or potentially cause interreactions with anesthesia.

Procedure

ELGP is an outpatient procedure made possible by the EndoCinch Suturing System. The ELGP procedure takes approximately two hours.

The procedure begins with a diagnostic endoscopy to confirm pre-procedure endoscopic findings. An esophageal overtube is placed over an esophageal dilator. The dilator is then removed and the overtube is left in place for the multiple endoscopic passes needed to create each plication. Using suction a fold of tissue is captured, and with the EndoCinch device it is stitched into a pleat or plication just below the lower esophageal sphincter muscle. This process is repeated for the necessary number of plications. Physicians report that the majority of patients require two plications.

Results

Over the past several years, clinical and economic studies at multiple U.S. clinical sites consistently report an immediate improvement in regurgitation and heartburn, as well as a significant reduction in the need for acid controlling medications. The results of a recent multi-center trial of GERD patients studied 9 to 12 months after undergoing the EGLP procedure, showed that 90% of patients reported complete resolution of their regurgitation, 85% reported complete resolution of their heartburn, and 74% reported complete discontinuation of all GERD medications.

Benefits

Unlike Nissen fundoplication, ELGP is performed as an outpatient procedure with a flexible endoscope. It does not involve an incision, hospitalization, or the use of general anesthesia. Generally, ELGP is more cost effective, introduces fewer side effects, and produces better results than long-term drug therapy. Patients return home the same day and return to normal daily activities the following day.

Summary

Endoluminal gastroplication is an outpatient procedure which is a much simpler, more cost-effective, less invasive treatment for gastroesophageal reflux disease, offering immediate relief and profoundly positive results, if not complete recovery from heartburn and acid reflux.