P1.034. Long Term Follow Up Electric Stimulation of LES in Esophageal Dismotility and Recurrent GERD

Abstract

Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Gastroesophageal reflux disease (GERD) recurrence after fundoplication is particularly challenging in patients with Barrett’s esophagus and esophageal aperistalsis. Lower esophageal sphincter electrical stimulation may improve reflux control while minimizing dysphagia and gas-bloat symptoms. Long-term outcomes in revisional foregut surgery remain poorly described, especially beyond 3 years. A retrospective longitudinal case series was conducted including seven patients with recurrent GERD after previous Nissen fundoplication between 2015 and 2025 at a tertiary foregut referral center. Inclusion criteria included recurrent reflux symptoms, Barrett’s esophagus confirmed endoscopically, esophageal aperistalsis demonstrated by high-resolution manometry, and long-term postoperative follow-up. All patients underwent laparoscopic redo Nissen fundoplication combined with implantation of a lower esophageal sphincter electrical stimulation device. Standardized preoperative evaluation included upper gastrointestinal endoscopy, esophageal manometry, pH monitoring when available, and clinical symptom assessment. Patients were followed prospectively at 1, 3, and 10 years postoperatively. Outcomes were assessed using Visick score, QoLQ-GERD questionnaire, upper gastrointestinal endoscopy, esophageal manometry, and pH monitoring when available. Results were categorized using a Likert-type scale ranging from satisfactory improvement to poor outcome. Descriptive analysis was performed because of the exploratory nature and small sample size. Seven patients were included (mean age 65 years; four males). Technical success was achieved in all procedures. Mortality was 0%, while morbidity was 14%, consisting of one incisional hernia at the battery reservoir site. Mean device implantation time was 35 minutes. At 1-year follow-up, five patients demonstrated satisfactory clinical outcomes (Visick I), one patient had intermediate symptoms, and one reported poor symptom control. By 3 years, all patients achieved Visick I status, with sustained symptom resolution maintained at 10 years. Quality-of-life outcomes progressively improved, with all patients reporting satisfactory QoLQ-GERD scores at long-term follow-up. Endoscopic evaluation demonstrated stabilization or improvement of Barrett-related findings without evidence of progression during surveillance. Manometric studies showed gradual functional improvement or stability over time. No patient required device removal, revisional surgery, or intervention for progressive dysphagia. Overall, combined redo fundoplication and LES electrical stimulation provided durable symptomatic and functional benefit during 10-year follow-up. Redo Nissen fundoplication combined with lower esophageal sphincter electrical stimulation demonstrated durable long-term symptomatic improvement, stabilization of Barrett-related endoscopic findings, and partial functional recovery in patients with recurrent GERD and severe esophageal dysmotility. Clinical outcomes improved progressively and remained stable over 10 years without significant dysphagia or device-related failure. LES neuromodulation may represent a valuable adjunct in highly complex revisional foregut surgery and warrants further investigation in larger multicenter studies.