Endoscopic valvuloplasty for GERD

Background: The transoral, endoscopic route has been suggested as a possibl e approach for the correction of severe gastroesophageal reflux. Such a pro cedure would involve no mobilization of the cardia or other structures. The optimal placement, number, and configuration of sutures remains undefined. Methods: With the use of a previously developed endoscopic sewing machine, this study was undertaken in baboons with two suture arrangements immediate ly below the lower esophageal sphincter. A linear arrangement (group I) and a circular arrangement (group II) were compared. During the 6 months after the procedure, the animals were evaluated using manometry, fluoroscopic ba rium swallow, upper gastrointestinal endoscopy, and a pressure volume test. Results: A significant increase in lower esophageal sphincter length was de monstrated only in group II (p = 0.010). A significant increase in lower es ophageal sphincter pressure was demonstrated only in group I animals (p = 0 .008). The abdominal length increased in group I (p = 0.004) and group II ( p = 0.004). The yield pressure and yield volume did not differ significantl y from those measured previously in control animals. No evidence of reflux, stricture formation, esophagitis, or other pathology was noted. Conclusions: Some manometric parameters associated with gastroesophageal re flux are altered by the endoscopic placement of sutures below the gastroeso phageal junction, with no associated serious complications.