Antireflux Transoral Incisionless Fundoplication Using Esophyx: The New York Evidence

Introduction: The North American experience with EsophyX is limited. The aim of this study was to assess the efficacy, outcome and safety of EsophyX for endolumenal fundoplication for patients with gastroesophageal reflux disease (GERD) at a single institution.

Methods: Data of consecutive patients who underwent transoral incisionless fundoplication using EsophyX was retrospectively analysed. All patients underwent a preoperative upper gastrointestinal endoscopy with biopsy and pH study. Symptom relief, pre operative and postoperative proton pump inhibitor (PPI) use was compared.

Results: 13 consecutive patients who underwent the procedure were included in the study, comprising of 9 males (69%) and 4 females. The mean age was 44 years (range 23-76).The mean body mass index was 25, with American Society Anesthesiology class of 2. Two patients had Barrett’s esophagitis but without dysplasia. Six patients had hiatal hernia with mean length of 2 cm and all of them were reduced by the procedure. Mean pre operative Hill grade of gastroesophageal valve was 3 and post operative Hill grade was 1. Mean preoperative DeMeester score was 33.5. The hospital stay was 1 day (range 1-2) and mean post operative follow up was 9 months. Post procedure, eight patients were asymptomatic and were off PPI while the other five patients had occasional symptoms that needed lower doses of PPI, as compared to their preoperative dosage. One patient developed radiological evidence of esophageal perforation that was managed conservatively.

Conclusion: This single center experience with EsophyX demonstrates that 8/13 (61%) of patients have complete symptom relief post procedure, while all patients had low PPI usage as compared to preoperative status. Further follow up and large scale studies are needed.

Session: Poster

Program Number: P264

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