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Surgical Endoscopy

, Volume 28, Issue 3, pp 1003–1009 | Cite as

Effect of electrical stimulation of the lower esophageal sphincter using endoscopically implanted temporary stimulation leads in patients with reflux disease

  • Rupa Banerjee
  • Nitesh Pratap
  • Rakesh Kalpala
  • D. Nageshwar Reddy
Article

Abstract

Background

Electrical stimulation therapy (EST) has been shown to increase lower esophageal sphincter (LES) pressure in animals; however, data on the effect of EST on LES pressure in patients with gastroesophageal reflux disease (GERD) are lacking.

Objective

The aim of our study was to investigate the effect of EST on LES pressure and esophageal function in patients with GERD.

Methods

Patients with a diagnosis of GERD responsive to proton pump inhibitors (PPIs), increased esophageal acid on 24-h pH monitoring off GERD medications, basal LES pressure >5 mmHg, hernia <2 cm and esophagitis <LA grade B were included. A temporary pacemaker lead was placed endoscopically in the LES by creating a 3 cm submucosal tunnel, secured to the esophagus using endoscopic clips along the body of the lead and exteriorized nasally. EST was delivered 6–12 h post-implant per protocol using (i) short-pulse 200 μs, 20 Hz, and (ii) intermediate-pulse 3 ms, 20 Hz, each for 20 min at varying amplitudes. High-resolution manometry was performed pre-, during and post-EST. Symptoms of heartburn, chest or abdominal pain and dysphagia pre-, during and post-stimulation and 7 days post-procedure were recorded. Continuous cardiac monitoring was performed during and after the EST to evaluate any effect of EST on cardiac rhythm.

Results

Six male patients (mean age 34.6 years) underwent successful endoscopic lead implantation; the first patient had premature lead dislodgement and did not undergo EST. The remaining five patients underwent successful EST. All patients had a significant increase in LES pressure with all sessions of EST. There was no effect on swallow-induced LES relaxation, And there were no EST-related adverse symptoms or any cardiac rhythm abnormalities.

Conclusions

In patients with GERD, short-term EST delivered using electrodes endoscopically implanted in the LES results in a significant increase in LES pressure without affecting patients’ swallow function or causing any adverse symptoms or cardiac rhythm disturbances. EST may offer a novel therapy to patients with GERD.

Keywords

Gastroesophageal reflux disease Lower esophageal sphincter Electrical stimulation Manometry 

Notes

Disclosures

The results of this study were presented at the Asia Pacific Digestive Disease Week 2010, Kuala Lumpur, Indonesia, and have been published in abstract form [16]. The study was funded by a research grant from EndoStim, B.V., The Hague, The Netherlands. The authors have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Rupa Banerjee
    • 1
  • Nitesh Pratap
    • 1
  • Rakesh Kalpala
    • 1
  • D. Nageshwar Reddy
    • 1
  1. 1.Asian Institute of GastroenterologyHyderabadIndia

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