Peroral Endoscopic Cardial Constriction with Band ligation for Gastroesophageal Reflux Disease: A Prospective Pilot Study

Background- Limited retrospective data suggest PECC-b (Peroral endoscopic cardial constriction with band ligation) as feasible, safe, and effective treatment for GERD. We performed prospective study to assess efficacy and safety of PECC-b for treatment of GERD. Methods We prospectively recruited proton pump inhibitor (PPI)-dependent GERD patients. Patients with absence of acid reflux on 24-hour pH study, esophageal motility disorder, and ≥Hill’s grade III hiatus on endoscopy were excluded. Primary endpoint was GERD health-related quality of life (GERD-HRQL) score improvement at 3 months. Secondary end points were decrease in PPI use, esophageal acid exposure time, reflux episodes, and DeMeester score at 3 months. Safety outcomes included serious and overall adverse events Results Between July 2023 and June 2025, 130 patients were screened. Of these, 40 patients underwent PECC-b therapy (median age 34(IQR: 18-60) years, 75% males) and were followed up for 3 months. At follow-up, significant improvement in GERD-HRQL scores (22.8±3.2 at baseline to 12 ±4.7; p<0.001) was observed. 85% (n=34) patients achieved complete or partial PPI independence at 3 months. Median acid exposure time decreased from 28.1%(IQR: 18.2%-54.5%) to 14.8% (8.0%-18.0%) (p<0.05), median number of reflux episodes from 81.5 (53.8-126) to 30 (21.8-70.8) (p<0.005), and Demeester score decreased from 103 (51-161) to 52.5(33.5-78.3) (p<0.005). 15(37%) patients had chest pain post-procedure and required analgesics. There were no serious procedure-related adverse events Conclusion PECC-b is a promising, safe, and effective endoscopic treatment for PPI dependent GERD, offering significant symptomatic relief and improvement in quality of life. Keywords- GERD-HRQL, Quality of Life, PPI