Antireflux Endoluminal Therapies: Past and Present

Abstract

The basic principle of antireflux procedures employing endoscopic intervention aims to create a mechanical barrier to prevent primary pathophysiology in gastroesophageal reflux disease (GERD). We review, highlight, and discuss the past and present status of endoluminal therapy. Currently, there are 3 commonly employed anti-reflux endoluminal procedures: fundoplication or suturing techniques (EndoCinch, NDO, and EsophyX), intramural injection or implant techniques (enhancing lower esophageal sphincter (LES) volume and/or strengthening compliance of the LES-Enteryx and Gatekeeper), and radiofrequency ablation of LES and cardia. EndoCinch plication requires further study and modification of technique before it can be recommended because of durability issues. Esophynx, the transoral incisionless fundoplication, may reduce hiatal hernias and increase LES length. Preliminary studies have shown promising reduction in symptoms and medication use but evidence concerning safety and long-term durability is still pending. The safety issue with injection technique is the main concern as evident from the incidences of implant withdrawals after reported major adverse events. Future research with cautious monitoring is required before any new implant material can be recommended for commercial application. Radiofrequency ablation therapy is regaining popularity in treating refractory symptoms despite PPI use due to improved efficacy, durability, and safety after years of refinement of protocol.

Endoscopic closure after intraluminal surgery

“…EndoCinch ® (Bard Endoscopic Technologies, Billerica, MA, USA) is one of the well‐researched suturing devices for gastroesophageal reflux disease . It consists of a metal capsule attached to the tip of an endoscope, thread, and a clip device for anchoring the stitches.…”

“…EndoCinch â (Bard Endoscopic Technologies, Billerica, MA, USA) is one of the well-researched suturing devices for gastroesophageal reflux disease. [81][82][83] It consists of a metal capsule attached to the tip of an endoscope, thread, and a clip device for anchoring the stitches. The mucosal layer of esophageal hiatal hernia is suctioned into the capsule and stitched by the needle and thread.…”

Hiatus hernia and gastro-oesophageal reflux disease

“…27 The use of a laparoscopically placed magnetic sphincter augmentation device, which strengthens the anti-reflux barrier extrinsically, has shown great promise. In a 100-person study of quality of life, oesophageal pH and freedom from daily PPI, all variables improved postoperatively with minimal adverse effects and preservation of gastric anatomy.…”

Endoscopic suturing for closure of transmural defects

“…Another class of endoscopic suturing devices uses an overtube with preloaded stitches (NDO plicator [NDO Surgical, Mansfield, MA] and EsophyX [EndoGastric Solutions, Redmond, WA]) [7,9]. The overtube has an internal lumen for a small-diameter endoscope, which is used only for observation and to guide the suture placement.…”

“…These devices were specifically designed for endoscopic treatment of gastroesophageal reflux disease. However, currently only the EsophyX system is still commercially available for clinical use [9].…”