Prof. Dr. Rudolph Pointner
Tauernklinikum Zell am See
Title: The GERD-X procedure personal casuistry and clinical outcomes
Biography
Biography: Prof. Dr. Rudolph Pointner
Abstract
The GERD-X procedure is a further development of the NDO-Plicator-System consisting of a flexible endoscope-like tube and a playstation-like operating console. In the front of the tube the needles and pretied sutures are hold in a closed snake- or crocodile-like mouth. The procedure is performed under direct vision of a retroflexed babyscope, which is passed through the inserted tube in a patient under general anaesthesia in normal back position. Once in appropriate position at the left side of the GE-junction the arms of the device are closed, deploying the implant which is made of pretied sutures and PTFE-blades. Subsequently after realising this first step, the device is removed, leaving a full thickness permanent suture plication of the gastric wall. This procedure is reproducible until the GE-junction is tight and shows a fundoplication-like gastroesophageal valve Hill Grade I.
Goal of the presentation is to present a series of 120 patients assigned to the GERD-X procedure. In all those patients a meticulous preoperative examination was performed, including endoscopic examination, cinematographic esophageal barium X-Ray-Studies, High resolution Manometry, Impedance pH-monitoring and quality of life score studies using the Gastrointestinal Quality of Life-Score according to Eypasch and Troidl. Exclusion criteria for performing the GERD-X-procedure in this series were defined as Hiatal hernias more than one centimetre detected in high resolution manometry and/or a gastroesophageal valve more than Hill Grade II.
Considerations: According to a detailed follow-up and analysis of our patients the focus for achieving good results has to be put on the exclusion criteria of a Hiatal hernia or gastroesophageal valve more than Hill Grade II and a sophisticated handling of the GERD-X device. Meeting these presumptions excellent results corresponding to the GIQLI-score can be achieved, although the number of reflux episods decreases only to the middle compared to a decrease of about 90% after a Nissen procedure.
Conclusion: The special merits of the GERD-X procedure are a high rate of patient – satisfaction according to the GIQLI – scores without producing complications or side effects as they are known after laparoscopic fundoplication.