Intraluminal Endoscopic Suturing - Assessment of the Mucosa

Endoscopic suturing causes modest but significant improvement in LES function. First, there is a significant reduction in the triggering of transient LES relaxations (tLESRs) and second, there is a small but significant increase in basal LES pressure. Overall, tLESRs were reduced by 37% at 6 months, but the overall number of reflux episodes was unchanged and there was only a modest decrease in upright GER (14.4% to 9.2%, median values at baseline and 6 months, p< 0.05) and no change in supine reflux. Nevertheless, 7 of 15 (45%) patients were free of symptoms and off medication at 1 yr and 4 of 15 (26%) patients had normal pH values. The speculated mechanism of these changes was twofold. First, the plication and possibly associated scarring just below the squamocolumnar junction may reduce the distensibilty of the cardia region of the stomach, the recognized trigger zone for tLESRs. Secondly, scarring may also affect neural pathways, thereby reducing the rate of tLESRs.