|Home | About | Journals | Submit | Contact Us | Français|
We congratulate Schwartz et al for their first reported Endocinch sham control trial (Gut 2007;56:20–8). The results of this trial confirm those of earlier open‐label studies1,2,3 showing that in the short and intermediate term, endoscopic gastroplication improves gastro‐oesophageal reflux disease symptoms and quality of life (QOL), and reduces the requirements of acid‐inhibitory drugs. In their current study design, they only performed endoscopy/gastroplications in patients who have treatment failure in the active treatment group, and hence the actual proportion of patients who have retention of stitches (or judged to be functional) is unknown in the active treatment group. However, the retention of stitches seems to be a major problem reported with this technique.4,5 In our group, we used only two plications 1 and 2 cm below the Z line along the lesser curve, and used the previous knot technique in comparison with a recent clip devise for anchoring sutures.1 However, better outcomes with three plications have been shown by Thompson et al.6 We have now completed a 5‐year postprocedural study on our group of patients. Although the number is small (n=22; 17 completed their 5‐year follow‐up for symptom scoring and usage of proton pump inhibitors (PPIs) and only 13 agreed for repeat endoscopy), it clearly showed potential to maintain significant control in gastro‐oesophageal reflux disease symptoms and QOL, and reduction in the requirements of PPIs up to 5 years after the procedure.7 To further determine whether retention of stitches is of significance, we further analysed our data. In our cohort, plications were intact in 70% of cases at 5 years after the procedure (confirmed by repeat endoscopy, which was performed by an independent blinded experienced endoscopist). It showed that the group of patients who retained plications showed significant improvement in symptom scoring (p=0.01), regurgitation score (p=0.007), QOL (p=0.02) and 67% reduction in the requirement of PPIs at 5 years after the procedure as compared with the group of patients who lost plications.8 Hence, long‐term failure seems to be related with loss of plications. At this stage of development, it is also important that those who are performing or have performed these procedures should follow‐up their cases to further assess the retention of plications and their durability. We believe that better sedation and increasing depth of sutures with increasing size of suction chamber may help in retention of sutures.9 However, further modifications are needed to improve this technique, in particular to improve the retention of sutures for achieving maximum clinical benefit.
Competing interests: None.