Endoluminal gastroplication for gastroesophageal reflux appearing after gastric surgery

Endoluminal gastroplication (ELGP) is a new endoscopic treatment for gastroesophageal reflux disease (GERD). However, its efficacy has been reported only for primary GERD but not for postoperative GERD. Here we report the first two cases of GERD that appeared after gastric surgery and were successfully treated by ELGP. Both patients developed GERD after gastric surgery. Esophagogastrofiberscopy showed esophagitis and small hiatal hernia. The symptoms failed to disappear after medical therapy and ELGP was performed. ELGP involved the use of the BARD (EndoCinchTM) endoscopic suturing system, where two to three plications were placed at the esophagogastric junction. Procedure time, start of soft diet and hospital stay were 55 min, the first postoperative day (POD), 5 days and 60 min, 1 POD and 5 days, for patients 1 and 2, respectively. No adverse events were noted apart from mild and transient epigastric pain. The GERD-related symptoms markedly improved after ELGP. Improvements were also noted in acid exposure time and bile reflux time after the procedure. ELGP is safe and effective for GERD that develops after surgery although this needs to be confirmed in long-term follow-up studies. ELGP is potentially suitable for GERD after Billroth-I distal gastrectomy with lymph node dissection for gastric cancer.