Thomson, M.A.; Afsal, N.; D'Souza, R.; Fritscher-Ravens, A.; Swain, P.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA19
Academic Journal
The aim of this work is to assess the safety and efficacy of endoscopic gastroplication (EG) (BARD Endocinch© device) for the treatment of GORD in children and adolescents. 20 patients (3 cerebral palsy, 8 male, median (range) age 12.8 years (6.1-17.7), weight 46 kg (16.5-75)) with symptoms of GORD dependent/refractory wrt PPIs for > 12 months underwent EG. Median follow up: 15 months. Exclusion criteria were age > 17 years, dysphagia, obesity (BMI) > 99th centile, previous upper Gl surgery, and hiatus hernia > 2 cm. Pre-procedure assessment included symptom scoring, upper Gl endoscopy, barium upper Gl series, oesophageal manometry (in 4), liquid/solid phase gastric scintiscan, 24 hour oesophageal pH, and completed reflux quality of life (QOLRAD) questionnaire. Post-procedure symptomatology, QOL and adverse events were assessed at 1, 3, 6, and 12 months. Repeat 24 h pH was performed at 2 months (16 patients). All occurred under general anaesthesia as is standard practice in paediatric endoscopy. The median duration of the procedure for 3 plications (3 pairs of sutures) was 65 min. The median heartburn symptom score (daily heartburn frequency x severity (0-10)) was 24 pre-procedure and 0 at six weeks and 6 months. Total, and all sub-parameters, of QOLRAD showed sustained improvement for the follow up period. Total QOLRAD (best 175) increased from a median of 83 (70142) to 157 (93-175) (p < 0.001). All pH parameters improved significantly. Median reflux index from 14.8% (0.9-67.9) to 2.7% (1.0-6.9) (p < 0.001). Median pH Demeester score From 67.1 (6.1-68.3) to 11.6 (5.0-31.2) (p < 0.001). 19/20 patients had a normal pH profile at 2 months and 19/20 did not require any further PPI use at any stage (median PPI dose pre-EG 0.89 (0.3-2.42) mg/kg/day. One patient had Iocolised gastric bleeding requiring red cell transfusion that settled spontaneously and no other adverse events were seen. This is the first study reporting paediatric experience with an endoscopic...


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