6533b7cffe1ef96bd1258c9a

RESEARCH PRODUCT

PS01.049: ENDOSTIM™ NON-RESPONDERS: AN ANALYSIS

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Abstract Background Electronic stimulation oft the lower esophageal sphincter (LES) is a new promising anti-reflux procedure that is established in Germany since 2014. Basically two leads are inserted laparoscopicaly into the LES and connected to an implantable pulse generator (IPG) which is placed in a subcutaneous pocket. This stimulation is supposed to build up the muscular anti-reflux barrier. It is limited to patients with a small hiatal hernia < 3 cm and reflux esophagitis LA Classification Type A-C. Although long-term results up to 4 years with a good postoperative reflux control and an increased quality of life have been published, no data about Endostim™ non-responders, difficult postoperative situations and procedure failure has been reported yet. Methods Between 12/2015 and 11/2017 12 patients underwent laparoscopy for an Endostim™ implantation. All patients had an upper endoscopy, a barium swallow, high-resolution esophageal impedance manomentry (HRIM), 24-hour multi-channel impedance and pH monitoring (MII-pH) prior to the procedure and after 6 months. The quality of life was assessed with the GERD health related quality of life (GERD-HRQL) questionnaire preoperatively and during further follow-up. Results 6 of 12 patients (50%), 2 female 4 male, reported new GERD symptoms after an initial postoperative symptom relief. 1 patient had a prolonged period (15 months) of reprogramming until complete symptom control was achieved. 1 patient had a recurrent 3 cm hiatal hernia after 3 months, so that only a partial responds was reported. In 2 patients reprogramming could not reach a proper responds. Two patients showed a complete technical failure due to a broken lead close to the IPG. Conclusion Reasons for Endostim™ failure can be heterogeneous. Because it is a young and new procedure non-responders should be investigated closely so that there can be a critical discussion about indications, contraindications and negative predictive factors. Disclosure All authors have declared no conflicts of interest.