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Evidence - EndoStim® Stimulation Therapy of the Lower Esophageal Sphincter

  1. Summary of the Literature

    The EndoStim system is CE-marked and has been in clinical use in Germany since 2013.

    The evaluation was conducted in a six-month pilot study1. 24 GERD patients with residual symptoms despite daily PPI intake, pathological pH-metry, and confirmed esophagitis participated. The EndoStim therapy significantly improved the endoscopic findings and pH-metry. The percentage of time with a pH < 4 decreased from 10.1% to 5.1% over 24 hours. Additionally, sphincter pressure increased significantly, and by the end of the study, 91% of participants were off PPIs. After another six months, the time with a pH < 4 was 3.3%, and 96% of patients were off PPIs2. The stimulation did not lead to unexpected complications. An international multicenter study confirmed these results3. In this study, the pacemaker reduced the percentage of pH time after half a year from 11.3% to 2.6%, and 92% of participants no longer took PPIs.

    The long-term results published three years after the first implantation of 21 patients also support the findings4. The period with pH values < 4 decreased from 10.1% to 4.1%. Disease-related quality of life improved significantly over two years, even compared to PPIs. Only four participants continued to take PPIs. Unexpected implant/stimulation-related complications or postoperative dysphagia did not occur. Finally, the interim analysis of an international multicenter study also showed that six months after the implantation of EndoStim, the GERD-related quality of life score of the 17 participants had significantly improved5. 88% of patients no longer needed PPIs. Again, the procedure offered high safety, and there were no stimulation-related gastrointestinal side effects.

    Worldwide, EndoStim has been used in more than 160 patients to date, and in Germany, it has been implanted in about 60 patients.

  2. Currently ongoing studies on this topic

    Currently none

  3. Literature on this Topic

    1. Leonardo Rodríguez et al., Surg Endosc 2013; 27: 1083-1092

    2. Leonardo Rodrígez et al., Endoscopy 2013; 45: 595-604

    3. Peter D. Siersema et al., UEGW 2013 (Abstract)

    4. Rodriguez L et al., Am J Gastroenterol 2013; 108: p.27 Abstract 81;

    5. Siersema P et al., Am J Gastroenterol 2013; 108: p. 28 Abstract 82

  4. Reviews

    Vaezi MF, Shaheen NJ, Muthusamy VR. State of Evidence in Minimally Invasive Management of Gastroesophageal Reflux: Findings of a Scoping Review. Gastroenterology. 2020 Oct;159(4):1504-1525. doi: 10.1053/j.gastro.2020.05.097.Epub 2020 Jul 1. Review.

    Heimbucher J. Innovative Techniques in Reflux Surgery - State of the Art. Zentralbl Chir. 2019 Apr;144(2):171-178. 

    Labenz J, Chandrasoma PT, Knapp LJ, DeMeester TR. Proposed approach to the challenging management of progressive gastroesophageal reflux disease. World J Gastrointest Endosc. 2018 Sep 16;10(9):175-183

    Tatum JM, Lipham JC. Extraluminal Approaches to Gastroesophageal Reflux Disease. Thorac Surg Clin. 2018 Nov;28(4):521-526. doi: 10.1016/j.thorsurg.2018.07.003. Review

    Stephan D, Attwood S, Labenz J, Willeke F. EndoStim® treatment-a new minimally invasive technology in antireflux surgery. Chirurg. 2018 Oct;89(10):785-792

    Rebecchi F, Allaix ME, Cinti L, Nestorović M, Morino M. Comparison of the outcome of laparoscopic procedures for GERD. Updates Surg. 2018 Sep;70(3):315-321.

    Labenz J, Koop H. Gastro-Oesophageal Reflux Disease - How to Manage if PPI are not Sufficiently Effective, not Tolerated, or not Wished? Laryngorhinootologie. 2018 Mar;97(3):166-175. 

  5. Guidelines

  6. literature search

    Literature search on the pages of pubmed.