Endoscopic implantation of a biopolymer in the lower esophageal sphincter for gastroesophageal reflux

A pilot study

Jacques Devière, Alfredo Pastorelli, Hubert Louis, Viviane De Maertelaer, Glen Lehman, Michele Cicala, Olivier Le Moine, David Silverman, Guido Costamagna

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Background: GERD is the most frequent disorder of the esophagus. Endoscopic minimally invasive treatment is desirable. However, the results of injection techniques have been disappointing. Methods: A pilot study was conducted in patients with GERD, who required continuous therapy with a proton pump inhibitor, in which ethylene-vinyl-alcohol was injected into the muscle of the gastric cardia. Primary endpoints were the safety of the procedure, the effect on lower esophageal sphincter pressure and the stability of the injected material. A secondary endpoint was the effect on heartburn score after discontinuation of treatment with a proton pump inhibitor. Results: Ethylene-vinyl-alcohol injection into the cardia resulted in circular diffusion of the product in 10 of 15 cases, suggesting that implantation into the muscle is feasible. Lower esophageal sphincter pressure was increased in 13 of 15 cases at 1 month and was sustained at a median follow-up of 6 months (range 4-12 months). Mean ± SEM of lower esophageal sphincter pressures (15 patients) were 12.2 ± 0.9, 18.7 ± 1.5 (p = 0.001 at baseline), and 16.7 ± 1.3 mm Hg (p = 0.038 from baseline) at, respectively, baseline, 1 month follow-up, and final follow-up. There was also a sustained reduction in heartburn score (off proton pump inhibitor) (3.40 ± 0.13 vs. 1.53 ± 0.24 and 1.87 ± 0.26 at baseline vs. 1 month and final follow-up, respectively; p <0.01). Nine of the 15 patients had more than 50% of the injected material in place at second follow-up (at 6 months for 8 patients; at 12 months for 1 patient). In only 2 patients was there loss of more than 75% of injected ethylene-vinyl-alcohol. Persistence of greater than 50% of the material was associated with achievement of a circular injection. Only 4 patients had to resume therapy with a proton pump inhibitor. Mild retrosternal discomfort was observed in 8 patients; this disappeared in all cases after a maximum of 3 days. Conclusions: Ethylene-vinyl-alcohol implantation in the muscle of the cardia is feasible and safe. It leads to a sustained increase in resting lower esophageal sphincter pressure. This is associated with a sustained improvement in heartburn score for patients who previously required continuous therapy with a proton pump inhibitor.

Original languageEnglish (US)
Pages (from-to)335-341
Number of pages7
JournalGastrointestinal Endoscopy
Volume55
Issue number3
DOIs
StatePublished - Mar 2002

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Lower Esophageal Sphincter
Biopolymers
Gastroesophageal Reflux
Proton Pump Inhibitors
Heartburn
Cardia
Alcohols
Pressure
Muscles
Injections
Therapeutics
Esophagus
Stomach
Safety
ethylene

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Endoscopic implantation of a biopolymer in the lower esophageal sphincter for gastroesophageal reflux : A pilot study. / Devière, Jacques; Pastorelli, Alfredo; Louis, Hubert; De Maertelaer, Viviane; Lehman, Glen; Cicala, Michele; Le Moine, Olivier; Silverman, David; Costamagna, Guido.

In: Gastrointestinal Endoscopy, Vol. 55, No. 3, 03.2002, p. 335-341.

Research output: Contribution to journalArticle

Devière, J, Pastorelli, A, Louis, H, De Maertelaer, V, Lehman, G, Cicala, M, Le Moine, O, Silverman, D & Costamagna, G 2002, 'Endoscopic implantation of a biopolymer in the lower esophageal sphincter for gastroesophageal reflux: A pilot study', Gastrointestinal Endoscopy, vol. 55, no. 3, pp. 335-341. https://doi.org/10.1067/mge.2002.121596
Devière, Jacques ; Pastorelli, Alfredo ; Louis, Hubert ; De Maertelaer, Viviane ; Lehman, Glen ; Cicala, Michele ; Le Moine, Olivier ; Silverman, David ; Costamagna, Guido. / Endoscopic implantation of a biopolymer in the lower esophageal sphincter for gastroesophageal reflux : A pilot study. In: Gastrointestinal Endoscopy. 2002 ; Vol. 55, No. 3. pp. 335-341.
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T2 - A pilot study

AU - Devière, Jacques

AU - Pastorelli, Alfredo

AU - Louis, Hubert

AU - De Maertelaer, Viviane

AU - Lehman, Glen

AU - Cicala, Michele

AU - Le Moine, Olivier

AU - Silverman, David

AU - Costamagna, Guido

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N2 - Background: GERD is the most frequent disorder of the esophagus. Endoscopic minimally invasive treatment is desirable. However, the results of injection techniques have been disappointing. Methods: A pilot study was conducted in patients with GERD, who required continuous therapy with a proton pump inhibitor, in which ethylene-vinyl-alcohol was injected into the muscle of the gastric cardia. Primary endpoints were the safety of the procedure, the effect on lower esophageal sphincter pressure and the stability of the injected material. A secondary endpoint was the effect on heartburn score after discontinuation of treatment with a proton pump inhibitor. Results: Ethylene-vinyl-alcohol injection into the cardia resulted in circular diffusion of the product in 10 of 15 cases, suggesting that implantation into the muscle is feasible. Lower esophageal sphincter pressure was increased in 13 of 15 cases at 1 month and was sustained at a median follow-up of 6 months (range 4-12 months). Mean ± SEM of lower esophageal sphincter pressures (15 patients) were 12.2 ± 0.9, 18.7 ± 1.5 (p = 0.001 at baseline), and 16.7 ± 1.3 mm Hg (p = 0.038 from baseline) at, respectively, baseline, 1 month follow-up, and final follow-up. There was also a sustained reduction in heartburn score (off proton pump inhibitor) (3.40 ± 0.13 vs. 1.53 ± 0.24 and 1.87 ± 0.26 at baseline vs. 1 month and final follow-up, respectively; p <0.01). Nine of the 15 patients had more than 50% of the injected material in place at second follow-up (at 6 months for 8 patients; at 12 months for 1 patient). In only 2 patients was there loss of more than 75% of injected ethylene-vinyl-alcohol. Persistence of greater than 50% of the material was associated with achievement of a circular injection. Only 4 patients had to resume therapy with a proton pump inhibitor. Mild retrosternal discomfort was observed in 8 patients; this disappeared in all cases after a maximum of 3 days. Conclusions: Ethylene-vinyl-alcohol implantation in the muscle of the cardia is feasible and safe. It leads to a sustained increase in resting lower esophageal sphincter pressure. This is associated with a sustained improvement in heartburn score for patients who previously required continuous therapy with a proton pump inhibitor.

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