Endoscopic implantation of Plexiglas (PMMA) microspheres for the treatmentof GERD

Background: A gelatinous implant containing polymethylmethacrylate (PMMA) b eads is successfully used to augment the diminished thickness of the choriu m in patients with skin defects and wrinkles, The aim of the present study was to determine whether submucosal injection of PMMA microspheres into the lower esophageal folds decreases the severity of symptoms and acid reflux in patients with GERD. Methods: Endoscopic submucosal implantation of PMMA was carried out in 10 p atients with GERD who were either refractory to or dependent on proton pump inhibitors. Symptom severity score, 24-hour pH monitoring, upper GI endosc opy, and EUS were performed to evaluate the efficacy of implantation. Results: A significant decrease in the symptom severity score and mean tota l time with esophageal pH less than 4 was noted after the implantation of P MMA (p < 0.05). Seven of 10 patients were taking no medication after PMMA i mplantation, There were no serious procedure-related complications. Conclusions: Endoscopic implantation of PMMA into the submucosa of the lowe r esophageal folds may be a new method for treating GERD, Further studies a re required to determine the longterm efficacy of the procedure.