HOME
Return to Table of Contents
110 A SYSTEMATIC REVIEW OF THE EFFICACY OF ENDOSCOPIC THERAPIES IN GASTRO-ESOPHAGEAL REFLUX DISEASE M Aghazahedi1, NJ Talley2, P Moayyedi1 INTRODUCTION: Endoscopic techniques such as radiofrequency application, injection of bulking agents (eg, enteryx) or gastroplication (eg, EndoCinch) are emerging therapies in the long term management of gastroesophageal reflux disease (GERD). Uncontrolled studies have given promising results, but the efficacy in randomized controlled trials (RCTs) is less certain. We have conducted a systematic review of RCTs that assess the efficacy of endoscopic therapy in patients with GERD.
1Gastroenterology Division, Department of Medicine, McMaster University, Hamilton, Ontario; 2Mayo Clinic, Rochester, Minnesota, USA
METHODS: Medline, Embase and Cochrane electronic databases were searched until July 2005. We also performed a recursive search of the literature from the bibliographies of potentially eligible studies. RCTs of adults comparing endoscopic therapies with an alternative therapy or sham procedures in patients with GERD (defined by pH studies or endoscopic esophagitis) were eligible. Eligibility assessment and data extraction was performed by two independent reviewers. The trial results were summarized as a relative risk (RR) of remaining symptomatic using a random effects model (DerSimonian and Laird, Stata version 8).
RESULT: One hundred seventeen articles were reviewed and six trials were eligible. One trial compared two different endoscopic therapies and five compared endoscopic therapy (one enteryx, one radiofrequency and three EndoCinch) with a sham procedure in a total of 254 GERD patients over at least three months. Three of four trials reported no difference in 24 h pH studies between sham and active endoscopic therapy at the end of the study period and very few patients completely discontinued proton pump inhibitor (PPI) therapy. There was a statistically significant reduction in reflux symptoms (RR 0.47; 95% CI 0.32 to 0.68) with no significant heterogeneity (P=0.52). There was a trend toward the reduction of daily PPI use although this did not reach statistical significance (RR 0.40; 95% CI 0.13 to 1.25, P=0.11) and there was significant heterogeneity between results (P=0.01). There were insufficient data to explore reasons for heterogeneity or evaluate the efficacy of different forms of endoscopic therapy separately.
CONCLUSION: More data are needed with a larger number of patients. At present the data suggest endoscopic therapy reduces reflux symptoms but not objective measures of esophageal acid exposure.