Efficacy of endoscopic radiofrequency ablation for proton pump inhibitor-dependent gastroesophageal reflux disease: Multicenter prospective cohort study

Objectives

To evaluate the effects of endoscopic radiofrequency ablation (RFA) on proton pump inhibitor (PPI)-dependent gastroesophageal reflux disease (GERD) in a Chinese population, and to explore the factors associated with favorable efficacy.

Methods

A multicenter, single-armed prospective cohort study was conducted. PPI-dependent GERD patients were enrolled and underwent RFA. The primary outcome was improvement of GERD health-related quality of life (GERD-HRQL). Secondary outcomes were symptom improvement, satisfaction, PPI use, and the indicators of 24-h pH-impedance monitoring. A nomogram to predict complete remission was constructed.

Results

In total, 66 patients were included. The GERD-HRQL score was significantly reduced at the 3 month (mean difference, 14.7 [12.6–16.9]), 6 month (mean difference, 15.9 [13.8–18.1]), 12 month (mean difference, 16.7 [14.4–18.9]), 24 month (mean difference, 18.4 [16.2–20.1]), 36 month (mean difference, 18.2 [16.3–20.4]), and 48 month follow-up (mean difference, 16.1 [14.2–18.3]), all P < 0.001. The esophageal and extra-esophageal symptom scores were all significantly decreased. The proportion of satisfaction and no PPI use were significantly higher. With regard to the indicators of 24-h pH-impedance monitoring, acid exposure time (AET), and DeMeester score, but not lower esophageal sphincter (LES) pressure, decreased significantly at the 12 month follow-up. A nomogram based on age, body mass index (BMI), baseline AET, and LES pressure was then constructed and showed good discrimination in the prediction of complete remission following RFA.

Conclusions

This study demonstrated that RFA improved life quality as well as symptoms in PPI-dependent GERD patients in a Chinese population. Younger age, higher BMI, lower baseline AET, and higher baseline LES pressure indicate favorable efficacy of RFA.