Efficacy and safety of endoscopic full-thickness plication for proton pump inhibitor–dependent gastroesophageal reflux disease: A single-center retrospective cohort study

Abstract Background: Proton pump inhibitors (PPIs) remain the cornerstone of gastroesophageal reflux disease (GERD) management. However, concerns over long-term use have prompted interest in alternatives. Endoscopic full-thickness plication (eFTP) is a minimally invasive approach designed to enhance lower esophageal sphincter (LES) function, while avoiding surgical morbidity. This study assessed the efficacy and safety of eFTP in patients with PPI-dependent GERD. Methods: This single-center retrospective cohort study included 85 patients, who underwent eFTP between December 2022 and March 2024. Data on demographics, symptom duration, PPI use, anatomical findings, postprocedural complications, and 12-month outcomes were collected. The primary endpoint was PPI discontinuation. Logistic regression was performed to identify predictors of successful PPI cessation. Results: Most patients were male (67.1%), and 73% were older than 35 years. Reflux symptoms had persisted for more than 3 years in 76.5% of patients, and 40% had used PPIs for over 5 years. eFTP was well tolerated, with 90.6% discharged within 24 hours. Adverse events were infrequent, including one leak (1.2%) and postprocedural pain in 10.6% of patients. Within 12 months, 57.6% achieved PPI discontinuation. Longer prior PPI use showed a trend toward improved outcomes, whereas a symptom duration of 2–3 years was associated with lower odds of PPI cessation ( P = 0.037). Other variables were not significant. Conclusion: eFTP was associated with reduced PPI dependence and an acceptable safety profile, representing a minimally invasive option for selected patients. Prospective controlled studies are needed to confirm long-term efficacy.