Endoscopic gastric plication for the treatment of GERD and underlying class I obesity

Abstract

GERD is a common gastrointestinal disorder that affects approximately 25% of the U.S. population. Several studies have demonstrated a higher prevalence of GERD in patients with obesity compared to those with a normal body mass index (BMI). Specifically, a gain of at least 3.5 kg/m in BMI is associated with a 3-fold increase in rates of GERD compared with those with a stable BMI. Potential mechanisms include an increase in intragastric pressure, transient relaxations of the lower esophageal sphincter, prevalence of hiatal hernia, esophageal dysmotility, and a decrease in lower esophageal sphincter pressure in patients with obesity. Approximately 30% of patients with GERD are refractory to proton pump inhibitors and may benefit from surgical fundoplication. Nevertheless, the long-term efficacy of fundoplication is suboptimal in patients with obesity, with a recurrence rate of 31% compared with 4.5% in those with a normal BMI. Furthermore, sleeve gastrectomy, which is the most common bariatric surgery, is a refluxinducing procedure, and gastric bypass is rarely performed in patients with class I obesity. Therefore, management of refractory GERD in this population remains challenging. In this video (Video 1, available online at www. giejournal.org), we demonstrate a novel use for endoscopic gastric plication to treat GERD and class I obesity in a single session.