Endocinch Procedure

The majority of the millions of gastroesophageal reflux disease (GERD) sufferers find relief with medications like proton pump inhibitors (PPIs) and H2 receptor blockers. Sometimes, surgical procedures such as the Nissen fundoplication or the Stretta procedure are necessary.

Another option in the battle against severe acid reflux is a surgery known as EndoCinch endoluminal gastroplication. The outcomes of this type of surgery have been mixed. However, it may be an option for those who don’t respond well to drugs or aren’t good candidates for Nissen fundoplication or other surgeries.

The Procedure

Like the Stretta procedure, EndoCinch endoluminal gastroplication surgery (ELGP) was approved by the U.S. Food and Drug Administration (FDA) in 2000 for the treatment of GERD. Also like Stretta, ELGP is an outpatient procedure that is far less invasive than the Nissen fundoplication.

ELGP combines endoscopy with a suturing system and is typically performed by an experienced endoscopist. The endoscopist uses a pair of video endoscopes, an esophageal overtube, and the EndoCinch Suturing System while the patient is under sedation.

The procedure usually takes less than two hours and involves the following steps:

  1. A diagnostic endoscopy confirms earlier endoscopic findings.
  2. An overtube is placed over an esophageal dilator.
  3. The dilator is removed and the overtube is left in place.
  4. The physician uses suction to capture a fold of tissue.
  5. Using the EndoCinch device (which resembles a miniature sewing machine), the physician stitches the tissue just below the lower esophageal sphincter (LES). Most patients require two or more stitches to strengthen the LES and prevent backup of stomach acids into the esophagus

Most patients who undergo the procedure return home the same day and can resume normal activities within 24 hours.

Results

In the short term, the EndoCinch endoluminal gastroplication produces good results. Ninety percent of patients reported complete resolution of regurgitation symptoms within 9 to 12 months after the procedure. Eighty-five percent had complete relief from heartburn. Additionally, 74 percent of patients were able to discontinue all GERD medications.

In Children

The EndoCinch endoluminal gastroplication may be a good option for children with severe GERD symptoms because of a lack of significant side effects. A 2006 study published in The Journal of Pediatric Gastroenterology and Nutrition found that, of 17 patients studied (median age 12.4 years), 88 percent were completely weaned off anti-reflux medications one year after the surgery.

Fifty-six percent were still off anti-reflux medications three years later. However, 25 percent of the children (four kids) required additional surgery between two and 24 months due to a recurrence of symptoms.

Researchers concluded that endoluminal gastroplication "is an effective and safe procedure in children. It is a viable option for the treatment of GERD refractory or those dependent on anti-reflux medications."

Drawbacks of the EndoCinch Endoluminal Gastroplication Surgery

Despite the success rates of the surgery, several studies confirm serious drawbacks to the procedure and question its long-term efficacy. According to an article published in the journal Gut in 2007, "the retention of stitches seems to be a major problem reported with this technique."

Just 70 percent of patients in one study still had all of their stitches after five years (and only 67 percent of them were still PPI-free). Researchers concluded that "long?term failure seems to be related with loss of plications [stitches]" and that "further modifications are needed to improve this technique."

The results of a German study published in the journal Endoscopy in 2005 were even more dismal. Only one of the 20 patients in the study who required three plications or less still had all the sutures in place six months after the surgery. Three more had lost all stitches.

Because of this, the study recommended that, even though it’s considered safe and easy to perform, EndoCinch endoluminal gastroplication shouldn’t be used as a treatment for gastroesophageal reflux disease "until further technical refinements allow sutures to be maintained in the long term."

It’s important to note that the manufacturer, Bard, has recently discontinued the EndoCinch Suturing System, making its future availability uncertain. Discuss the availability and viability of this procedure with your doctor to determine if it’s an option for you.