PMID- 25047169
OWN - NLM
STAT- MEDLINE
DCOM- 20150622
LR  - 20211021
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 28
IP  - 12
DP  - 2014 Dec
TI  - Long-term results of electrical stimulation of the lower esophageal sphincter for 
      treatment of proximal GERD.
PG  - 3293-301
LID - 10.1007/s00464-014-3603-x [doi]
AB  - INTRODUCTION: Electrical stimulation of the lower esophageal sphincter (LES) in 
      gastroesophageal reflux disease (GERD) patients, using EndoStim((R)) LES 
      stimulation system (EndoStim BV, the Hague, Netherlands), enhances LES pressure, 
      decrease distal esophageal acid exposure, improves symptoms, and eliminates the 
      need in many patients for daily GERD medications. AIM: To evaluate, in a post hoc 
      analysis, the effect of LES stimulation on proximal esophageal acid exposure in a 
      subgroup of patients with abnormal proximal esophageal acid exposure. METHODS: 
      Nineteen patients (median age 54 years; IQR 47-64; men-10) with GERD partially 
      responsive to proton pump inhibitors (PPI), hiatal hernia </= 3 cm, esophagitis </= 
      LA grade C underwent laparoscopic implantation of the LES stimulator. LES 
      stimulation at 20 Hz, 215 mus, 5-8 m Amp sessions was delivered in 6-12, 30 min 
      sessions each day. Esophageal pH at baseline and after 12-months of LES 
      stimulation was measured 5 and 23 cm above the manometric upper border of LES. 
      RESULTS: Total, upright and supine values of median (IQR) proximal esophageal pH 
      at baseline were 0.4 (0.1-1.4), 0.6 (0.2-2.3), and 0 (0.0-0.2) %, respectively, 
      and at 12 months on LES-EST were 0 (0-0) % (p = 0.001 total and upright; p = 
      0.043 supine comparisons). 24-hour distal esophageal acid exposure improved from 
      10.2 (7.6-11.7) to 3.4 (1.6-7.0) % (p = 0.001). Seven (37%) patients had abnormal 
      (>1.1%) 24-hour proximal acid exposure at baseline; all normalized at 12 months 
      (p = 0.008). In these 7 patients, total, upright, and supine median proximal acid 
      exposure values at baseline were 1.7 (1.3-4.1), 2.9 (1.9-3.7), and 0.3 (0-4.9) %, 
      respectively, and after 12 months of LES-EST were 0 (0-0.0), 0 (0-0.1), and 0 
      (0-0) % (p = 0.018 total and upright; p = 0.043 supine comparisons). Distal 
      esophageal pH for this group improved from 9.3 (7.8-17.2) at baseline to 3.2 
      (1.1-3.7) % at 12-months (p = 0.043). There were no GI side effects such as 
      dysphagia, gas-bloat or diarrhea or device or procedure related serious adverse 
      events with LES-EST. There was also a significant improvement in their GERD-HRQL 
      scores. CONCLUSION: LES-EST is associated with normalization of proximal 
      esophageal pH in patients with GERD and may be useful in treating those with 
      proximal GERD. The LES-EST is safe without typical side effects associated with 
      traditional antireflux surgery.
FAU - Hoppo, Toshitaka
AU  - Hoppo T
AD  - Institute for the Treatment of Esophageal & Thoracic Disease, The Western 
      Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA, USA, 
      thoppo@wpahs.org.
FAU - Rodriguez, Leonardo
AU  - Rodriguez L
FAU - Soffer, Edy
AU  - Soffer E
FAU - Crowell, Michael D
AU  - Crowell MD
FAU - Jobe, Blair A
AU  - Jobe BA
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20140722
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Electric Stimulation Therapy/instrumentation/methods
MH  - *Esophageal Sphincter, Lower
MH  - Esophageal pH Monitoring
MH  - Female
MH  - Follow-Up Studies
MH  - Gastroesophageal Reflux/diagnosis/*therapy
MH  - Humans
MH  - Laparoscopy
MH  - Male
MH  - Manometry
MH  - Middle Aged
MH  - Prospective Studies
MH  - Treatment Outcome
EDAT- 2014/07/23 06:00
MHDA- 2015/06/24 06:00
CRDT- 2014/07/23 06:00
PHST- 2014/01/29 00:00 [received]
PHST- 2014/05/03 00:00 [accepted]
PHST- 2014/07/23 06:00 [entrez]
PHST- 2014/07/23 06:00 [pubmed]
PHST- 2015/06/24 06:00 [medline]
AID - 10.1007/s00464-014-3603-x [doi]
PST - ppublish
SO  - Surg Endosc. 2014 Dec;28(12):3293-301. doi: 10.1007/s00464-014-3603-x. Epub 2014 
      Jul 22.