European Surgery

, Volume 46, Issue 2, pp 57–64 | Cite as

Electrical stimulation of the lower oesophageal sphincter: an emerging therapy for treatment of GORD

  • E. Eypasch



A significant proportion of gastro-oesophageal reflux patients remain unsatisfied with medical treatment and suffer from residual symptoms or quality-of-life issues. Anti-reflux surgery demonstrates excellent results in clinical trials, but is not widely utilized due to concerns of side effects, long-term failures and suboptimal results from low-volume centres. Hence, the search for a less invasive treatment has been an active area of clinical development. Electrical stimulation is increasingly utilized for various neuromuscular disorders and has recently emerged as a new minimally invasive treatment option for gastro-oesophageal reflux disease (GORD) by modulating the dysfunctional lower oesophageal sphincter.


This review article includes available data from five peer-reviewed publications summarizing three human trials. Abstracts from major international conferences provided additional long-term results and interim data on an ongoing international trial. Four published trials with animal data are also reported.


Published in vivo animal studies showed that electrical stimulation can be safely used to enhance lower oesophageal sphincter pressure. Feasibility clinical trials with temporary stimulation reproduced this effect in GORD patients and demonstrated preservation of swallow function. Two long-term trials showed improvement in oesophageal acid exposure, GORD symptoms and proton pump inhibitor (PPI) medications use with minimal side effects.


Enhancement of the anti-reflux function of the lower oesophageal sphincter using electrical stimulation is a safe and effective GORD treatment and can potentially address the unmet need of patients who are unsatisfied with PPIs. Additional data will help in a wider adoption of this technology.


GORD gastro-oesophageal reflux disease Lower esophageal sphincter Electrical stimulation 


Conflict of interest

The author has received clinical research grant and honorarium for speaking engagements from EndoStim Inc.


  1. 1.
    El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2013. doi:10.1136/gutjnl-2012-304269.Google Scholar
  2. 2.
    Nocon M, Labenz J, Jaspersen D, Meyer-Sabellek W, Stolte M, Lind T, Malfertheiner P, Willich SN. Long-term treatment of patients with gastro-oesophageal reflux disease in routine care—results from the ProGERD study. Aliment Pharmacol Ther. 2007;25(6):715–22.PubMedCrossRefGoogle Scholar
  3. 3.
    Gisbert JP, Cooper A, Karagiannis D, Hatlebakk J, Agréus L, Jablonowski J, Nuevo J. Impact of gastroesophageal reflux disease on work absenteeism, presenteeism and productivity in daily life: a European observational study. Health Qual Life Outcomes. 2009;7:90.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Khan M, Santana J, Donnellan C, Preston C, Moayyedi P. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev. 2007;(2):CD003244.Google Scholar
  5. 5.
    Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut. 2012;61:1340–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Galmiche JP, Hatlebakk J, Attwood S, Ell C, Fiocca R, Eklund S, Långström G, Lind T, Lundell L. Laparoscopic antireflux surgery vs. esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. JAMA. 2011;305(19):1969–77.PubMedCrossRefGoogle Scholar
  7. 7.
    Finks JF, Wei Y, Birkmeyer JD. The rise and fall of antireflux surgery in the United States. Surg Endosc. 2006;20(11):1698–701.PubMedCrossRefGoogle Scholar
  8. 8.
    Pandolfino JE, Krishnan K. Do endoscopic anti-reflux procedures fit in the current treatment paradigm of GERD? Clin Gastroenterol Hepatol. 2013;12(4):544–54. pii:S1542-3565(13)00871-9.Google Scholar
  9. 9.
    Sanmiguel CP, Hagiike M, Mintchev MP, Cruz RD, Phillips EH, Cunneen SA, Conklin JL, Soffer EE. Effect of electrical stimulation of the LES on LES pressure in a canine model. Am J Physiol Gastrointest Liver Physiol. 2008;295(2):G389–94.CrossRefGoogle Scholar
  10. 10.
    Ellis F, Berne TV, Settevig K. The prevention of experimentally induced reflux by electrical stimulation of the distal oesophagus. Am J Surg. 1968;115:482–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Clarke JO, Jagannath SB, Kalloo AN, Long VR, Beitler DM, Kantsevoy SV. An endoscopically implantable device stimulates the lower oesophageal sphincter on demand by remote control: a study using a canine model. Endoscopy. 2007;39:72–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Kantsevoy SV, Long VR, Jagannath SB, Hwang E, Brehon B, Beitler DM, Kalloo AN. An endoscopically implantable on-demand stimulator is successful in increasing lower oesophageal sphincter pressure in a porcine model. Gastrointest Endosc. 2005;61(5):AB79.Google Scholar
  13. 13.
    Banerjee R, Pratap N, Kalpala R, Reddy DN. Effect of electrical stimulation of the lower oesophageal sphincter using endoscopically implanted temporary stimulation leads in patients with reflux disease. Surg Endosc. 2014 Mar;28(3):1003–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Rodriguez L, Rodriguez P, Gomez B, Ayala JC, Saba J, Perez-Castilla A, Galvao Neto M, Crowell MD. Electrical stimulation therapy of the lower oesophageal sphincter is successful in treating GERD: final results of open-label prospective trial. Surg Endosc. 2013;27:1083–92.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Rodríguez L, Rodríguez P, Neto MG, Ayala JC, Saba J, Berel D, Conklin J, Soffer E. Short-term electrical stimulation of the lower oesophageal sphincter increases sphincter pressure in patients with gastroesophageal reflux disease. Neurogastroenterol Motil. 2012;24(5):446–50.PubMedCrossRefGoogle Scholar
  16. 16.
    Rodriguez L, Rodriguez P, Gomez B, Ayala JC, Oksenberg D, Perez-Castilla A, Netto MG, Soffer E, Crowell MD. Long-term results of electrical stimulation of the lower oesophageal sphincter for the treatment of gastroesophageal reflux disease. Endoscopy. 2013;45:595–604.PubMedCrossRefGoogle Scholar
  17. 17.
    Rodriguez L, Rodriguez P, Gomez B, Galvao M, Soffer E, Crowell M. Electrical simulation therapy (EST) of the lower oesophageal sphincter (LES) is successful in treating GERD—long-term two year results. Am J Gastroenterol. 2013;108:S27.Google Scholar
  18. 18.
    Siersema PD, Bredenoord AJ, Escalona A, Conchillo J, Booth M, Ruurda J, Wu J, Reddy DN, Soffer E. Electrical stimulation therapy (EST) of the lower oesophageal sphincter (LES)—an effective therapy for refractory GERD—interim results of an international multicenter trial. Am J Gastroenterol. 2013;108:S28.Google Scholar
  19. 19.
    Rinsma NF, Conchillo JM, Bredenoord AJ, Ruurda JP, Bouvy DN, van Berge Henegouwen MI, Chiu PW, Booth M, Hani AC, Reddy DN, Smout AJ, Wu JC, Escalona A, Siersema PD. Lower oesophageal sphincter (LES) electrical stimulation improves sleep quality and work productivity in patients with refractory GERD. Surg Endosc. In Press 2014.Google Scholar

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  1. 1.Chefarzt der Klinik für Allgemein-, Viszeral- und UnfallchirurgieHeilig Geist-Krankenhaus Köln LongerichCologneGermany

Personalised recommendations