Electrical stimulation of the lower esophageal sphincter may be a safe and effective treatment for proximal GERD, according to data presented at the Society of American Gastrointestinal and Endoscopic Surgeons Annual Meeting in Baltimore.
Researchers evaluated 19 patients with GERD who were laparoscopically implanted with the EndoStim lower esophageal sphincter (LES) stimulation system (EndoStim, The Hague, Netherlands). All patients had been at least partially responsive to proton pump inhibitor therapy. After implantation, patients received between six and 12 30-minute sessions of electrical stimulation at 20 Hz, 220 mcs, 5-8 mA, with esophageal acid exposure measured upon initiation and after 12 months of treatment.
The cohort had median proximal esophageal acid exposure levels of 0.6% upright, 0% supine and 0.4% total at baseline. All levels dropped to 0% after therapy, with a difference observed for each value (P=.001 for upright and total levels and P=.043 for supine levels). Investigators also noted significant improvement to distal esophageal pH in the cohort (10.2% to 3.6%; P=.001).
Among seven participants with abnormal proximal esophageal acid exposure at baseline, all experienced normalization after treatment, with median values of 2.9% for upright, 0.3% for supine and 1.7% for total exposure all at 0% after 12 months (P=.008 overall, P=.018 for upright and total values and P=.043 for supine). These patients also experienced significant improvement to distal esophageal pH (9.3% to 3.4%; P=.043).
No patients reported GI-related side effects, including diarrhea, gas-bloat or dysphagia during the study. No serious adverse events related to the device or implantation occurred.
“Electrical stimulation therapy of the LES is associated with normalization of proximal esophageal acid exposure in patients with GERD and may be useful in treating proximal GERD,” the researchers concluded. “The LES electrical stimulation therapy is safe and not associated with GI side effects seen with typical antireflux surgery.”
For more information:
Crowell MD. S066: Lower Esophageal Sphincter (LES) Electrical Stimulation Eliminates Proximal Esophageal Acid Exposure in Patients With GERD – One Year Results. Presented at: the Society of American Gastrointestinal and Endoscopic Surgeons 2013 Annual Meeting; April 17-20, Baltimore.