Feasibility of resection and plication “RAP” technique for management of medically refractory GERD in patients with altered gastric anatomy

Patrick R. Walsh; Mehul Lamba; Petros Benias; Abdulnasser Lafta; George Hopkins

doi:10.1055/a-1535-1279

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(10): E1549-E1555
DOI: 10.1055/a-1535-1279

Original article

Feasibility of resection and plication “RAP” technique for management of medically refractory GERD in patients with altered gastric anatomy

Patrick R. Walsh

¹St. Vincent’s Private Hospital Northside, Chermside, Australia

²Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia

,

Mehul Lamba

²Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia

,

Petros Benias

³Division of Gastroenterology, North Shore-Long Island Jewish Medical Center, Zucker school of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, New York, United States

,

Abdulnasser Lafta

²Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia

,

George Hopkins

¹St. Vincent’s Private Hospital Northside, Chermside, Australia

²Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia

› Author Affiliations

Abstract

Background and study aims Gastroesophageal reflux disease (GERD) is common, especially in patients after gastric surgery. Medical management of GERD is ineffective in up to 30 % patients and revisional gastric surgery for management of GERD is associated with higher morbidity. We aimed to assess the safety, feasibility, and efficacy of a novel endoscopic resection and plication (RAP) anti-reflux procedure for management of medically refractory GERD in patients with altered gastric anatomy.

Patients and methods The RAP procedure involves endoscopic mucosal resection and full-thickness plication over the right posterior-medial axis extending 15 mm above and 20 to 30 mm below the squamocolumnar junction. Adverse events, technical feasibility, GERD health-related quality-of-life (GERD-HRQL) scores, and medication use were prospectively recorded.

Results Twenty consecutive patients with previous gastric surgery underwent RAP between September 2018 and August 2020 with a median follow-up of 5.7 months. The median procedure duration was 66 minutes (IQR 53.8–89.5). RAP was technically successful in 19 patients. One patient developed gastric hemorrhage from suture dehiscence, which was managed endoscopically, and four patients developed esophageal stricture requiring endoscopic dilation. Following the RAP procedure, significant improvement in GERD-HRQL score was observed (mean 26.9, 95 %CI 23.36–30.55, P < 0.01). Fourteen of 19 patients reported > 50 % improvement in GERD-HRQL scores. Sixteen of 18 patients reported reduction in requirement for or cessation of antacid therapy.

Conclusions Patients with refractory GERD after gastric surgery have limited therapeutic options. We have demonstrated that the RAP procedure is feasible, safe, and clinically effective at short-term follow-up. It provides a potential alternative to revisional surgery in patients with altered gastric anatomy.

Full Text

References

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