Effect of endoscopic augmentation of the lower oesophageal sphincter (Gatekeeper reflux repair system) on intraoesophageal dynamic characteristics ot acid reflux

Cicala, M.; Gabbrielli, A.; Emerenziani, S.; Guarino, M. P. L.; Ribolsi, M.; Caviglia, R.; Costamagna, G.
February 2005
Gut;Feb2005, Vol. 54 Issue 2, p183
Academic Journal
Background and aims: Improvements in symptoms following endoscopic procedures for gastro- oesophageal reflux disease (GORD) are seldom supported by normalisation of acid exposure time at the distal oesophagus. However, the distribution of gastric acid within the proximal oesophagus is a main determinant of symptom generation in GORD patients. In this study, our aim was to assess the effect of endoscopic insertion of hydrogel expandable prostheses into the oesophageal submucosa on spatiotemporal characteristics of gastrooesophageal reflux. Methods: Oesophageal manometry and multichannel ambulatory 24 hour pH monitoring were carried out in nine patients before and six months after the endoscopic procedure. Dynamic characteristics of gastro-oesophageal reflux in patients were also compared with those in 13 asymptomatic controls. Results: Acid exposure time (AET) at the distal oesophagus decreased from 11.7% (95% confidence interval 6.1-21.8) at baseline to 7.7% (3.7-11.6) at follow up (NS). Of the nine patients, distal AET normalised in three. AET at the middle (7.6% (2.9-1 2.3)) and proximal (2.4% (0.1-4.8)) oesophagus decreased significantly in all patients (2.4% (0.3-4.5), p <0.01; 1.2% (0.2-2.2), p<0.05 respectively). Proximal extent of acid events significantly decreased in all patients at follow up (37.3% v 9.5%), reaching values observed in asymptomatic controls. Median GORD health related quality of life scores significantly improved from 35.5 at baseline to 9.4. Conclusions: Despite the lack of a significant improvement in traditional pH variables, endoscopic implant of hydrogel prostheses above the lower oesophageal sphincter significantly decreases proximal spread of acid reflux into oesophageal body. This effect would explain the improvement in symptoms in patients six months after therapy.


Related Articles

  • Truly stentless molded autologous pericardial aortic valve prosthesis with single point attached commissures in a sheep model. Goetz, Wolfgang A.; Tan, Teing Ee; Lim, Khee Hiang; Salgues, Sidney Le Hung; Grousson, Nil; Xiong, Fangli; Chua, Yeow Leng; Yeo, Joon Hock // European Journal of Cardio-Thoracic Surgery;Apr2008, Vol. 33 Issue 4, p548 

    Abstract: Objective: Aortic valve cusp extension and free-hand aortic valve replacement with autologous pericardium has been described. The long-term results were shown to be comparable with commercially available aortic bioprostheses. Nevertheless the relatively demanding surgical technique...

  • Laparoscopic Transgastric Removal of an Eroded Angelchik Prosthesis. Carbonell, Alfredo M.; Maher, James W. // American Surgeon;Aug2006, Vol. 72 Issue 8, p724 

    The Angelchik prosthesis is a silicone gel-filled implant historically placed around the gastroesophageal junction for the treatment of gastroesophageal reflux disease. Herein, we describe the laparoscopic transgastric removal of an Angelchik prosthesis that had eroded through the...

  • Disappearance of an Anglechik prosthesis. Gill, I. S.; Millar, D. // Journal of the Royal Society of Medicine;Aug1988, Vol. 81 Issue 8, p475 

    Since 1979 when Anglechik and Cohen reported their experience with the silicone gel prosthesis, over 15000 devices have been implanted. With more widespread use, reports of serious complications have appeared. One case of complete oesophageal transection, oesophago-gastric fistula and...

  • Sectional impressions and simplified folding complete denture for severe microstomia.  // British Dental Journal;2/26/2011, Vol. 210 Issue 4, p163 

    Provision of an upper full prosthesis in a patient with severely reduced mouth opening.

  • Shoulder arthroplasty. Buck, Florian; Jost, Bernhard; Hodler, Juerg // European Radiology;Dec2008, Vol. 18 Issue 12, p2937 

    Shoulder prostheses are now commonly used. Clinical results and patient satisfaction are usually good. The most commonly used types are humeral hemiarthroplasty, unconstrained total shoulder arthroplasty, and semiconstrained inversed shoulder prosthesis. Complications of shoulder arthroplasty...

  • Respuesta al comentario del Dr. Guillermo Peña Cabús. Velayos, Jorge Amorrortu // Cirugía Plástica Ibero-Latinoamericana;2010, Vol. 36 Issue 2, p125 

    No abstract available.

  • The Lichtenstein repair in 2002: an overview of causes of recurrence after Lichtenstein tension-free hernioplasty. Amid, P. // Hernia;Mar2003, Vol. 7 Issue 1, p13 

    Lichtenstein tension-free hernioplasty began in 1984. Based on our own mistakes, in the late 1980s, we established a set of key principles and reported the causes of our recurrences. Recently, other authors analyzing the causes of their own recurrences with tension-free repair are drawing the...

  • Osteogenesis of the Mandible Associated with Implant Reconstruction: A Patient Report. Taylor, Thomas D. // International Journal of Oral & Maxillofacial Implants;Fall1989, Vol. 4 Issue 3, p133 

    A patient report is presented illustrating bone growth of the posterior mandible associated with a fixed implant reconstruction of the Brånemark type. In this instance, the mandible had grown vertically approximately 3 mm and was causing discomfort beneath the cantilever sections of the...

  • Measurements of Talus for Sizing Tatar Body Prosthesis. Harnroongroj, Thossart; Shutithammanun, Luck // Thai Journal of Surgery;Jul-Sept2004, Vol. 25 Issue 3, p91 

    Background: Talar body prosthesis insertion is an option for preserving the function of the ankle and foot that suffers from avascular necrosis of talus. However, talus size varies between individuals. Knowledge of the dimensions and the curve angles of the talus is necessary for sizing talar...


Read the Article


Sign out of this library

Other Topics