The Plicator Procedure is an Alternative for the Treatment of Gastroesophageal Reflux Disease

Abstract

Objective: Endoscopic full-thickness plication of the gastric cardia using the Plicator is shown to be effective for the treatment of symptomatic gastroesophageal reflux disease (GERD). This retrospective study aimed to evaluate the Plicator procedure as an alternative to surgery. Materials and Methods: Patients who had at least one typical reflux symptom after 6 months of PPI therapy, who were observed to have reflux findings endoscopically (LA A or B and no Barrett’s metaplasia), with pathologic acid exposure in pHmetry results, hiatal hernia of <2 cm and Hill grade II and III, older than 18 years and not pregnant were included. The Plicator procedure was done endoscopically. Patients were controlled endoscopically and with pHmetry (if required) after 2 months and 1 year. Results: The 12-month follow-up assessment was completed in 185 patients. 120 patients (65% of patients) had no reflux symptoms or endoscopic findings. 33 patients were operated on for reflux disease. Conclusion: This is the largest published report of the Plicator procedure used for reflux patients as an alternative to surgery and 65% success rate is seen after one year. This procedure is a valid alternative for reflux patients who are unresponsive to PPIs, do not want to use long-term PPI medication due to symptom recurrence or opt for surgery