A novel endoloop pretest to treat severe gastroesophageal reflux disease symptoms before anti-reflux mucosectomy

A 44-year-old man with a 6-year history of gastroesophageal reflux disease (GERD; score of 30 on GERD questionnaire) underwent an upper gastrointestinal (GI) endoscopy, which revealed esophagitis (Los Angeles grade A). After failure of maximal medical therapy for GERD, the patient underwent a new minimally invasive, reversible endoscopic treatment, with the aim of predicting whether his symptoms could be alleviated, in order to ultimately decide whether to undergo irreversible surgery or endoscopic treatment.

A novel LeCamp endoloop (Leo Medical, China) ([Fig. 1]) was inserted into the gastric cardia using forceps passed through a single-channel endoscope ([Fig. 2 a]). After adjustment of the location and angle of the endoloop, it was anchored onto the edge of the gastric cardia with a clip ([Fig. 2 b]) and another one or two clips were inserted to hold the opposite side of endoloop about halfway round the circumference ([Fig. 2 c]). The hook was then connected with the endoloop ([Fig. 2 d]), which was tightened with a slight pulling together of all the clips ([Fig. 2 e]). The patient did not experience any pain and was safely discharged the same day.

Fig. 1 The LeCamp endoloop.

Fig. 2 White-light endoscopy views showing: a the gastric cardia; b the endoloop being fixed with the first clip using forceps passed through a single-channel endoscope; c a second clip being applied halfway around the circumference of the cardia; d the hook being connected to tighten the endoloop; e the gastric cardia in retroflexed view after the endoloop has been fixed and tightened.

After the treatment, the patient showed significant improvement in his symptoms with a score of 4 points on the GERD questionnaire and was able to discontinue daily use proton pump inhibitors. At 1-month follow-up, the patient complained that the symptoms were gradually re-appearing, repeat upper GI endoscopy revealed the endoloop and the clips had dropped off. After the patient had given his consent, anti-reflux mucosectomy (ARMS) was performed using standard endoscopic submucosal dissection [1]. At the 3-month follow-up, he reported significant reduction in GERD questionnaire scores and his upper GI endoscopy showed a tight gastroesophageal junction ([Fig. 3]).

Fig. 3 Endoscopic appearance 3 months after undergoing anti-reflux mucosectomy showing a tight gastroesophageal junction.

In this patient, we used a novel pretest to narrow the gastric cardia before he underwent ARMS, which suggests that this new technique may be a simple and reversible method to control symptoms temporarily in GERD patients, while they decide whether to undergo irreversible surgery or endoscopic treatment.

Video 1 A novel endoloop pretest to treat severe gastroesophageal reflux disease symptoms before anti-reflux mucosectomy in a 44-year-old man.

Endoscopy_UCTN_Code_CCL_1AB_2AC_3AC

Competing interests

None

• Reference

• 1 Inoue H, Ito H, Ikeda H. et al. Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: a pilot study. Ann Gastroenterol 2014; 27: 346-351