Endoscopic Management of Gastroesophageal Reflux Disease: Revisited

Abstract

Gastroesophageal reflux disease (GERD) is defined by the presence of troublesome symptoms resulting from the reflux of gastric contents. The prevalence of GERD is increasing globally. An incompetent lower esophageal sphincter underlies the pathogenesis of GERD. Proton pump inhibitors (PPIs) form the core of GERD management. However, a substantial number of patients do not respond well to PPIs. The next option is anti-reflux surgery, which is efficacious, but it has its own limitations, such as gas bloating, inability to belch or vomit, and dysphagia. Laparoscopic placement of magnetic augmentation device is emerging as a useful alternative to conventional anti-reflux surgery. However, invasiveness of a surgical procedure remains a concern for the patients. The proportion of PPI non-responders or partial responders who do not wish for anti-reflux surgery defines the ‘treatment gap’ and needs to be addressed. The last decade has witnessed the fall and rise of many endoscopic devices for GERD. Major endoscopic strategies include radiofrequency ablation and endoscopic fundoplication devices. Current endoscopic devices score high on subjective improvement, but have been unimpressive in objective improvement like esophageal acid exposure. In this review, we discuss the current endoscopic anti-reflux therapies and available evidence for their role in the management of GERD.

Updates on Management of GERD Disease

“…Endoscopic fundoplicatio with GERD-X The novelty of platelets: From a couple of years, though, the new GERD-X system applies the stitches [36], fired from the stapler, which have, at their ends, two plates, of poly-tetra-fluoro-ethylene (PTFE), which reinforce the suture and make it resistant to traction, exercised from the tissues. These platelets, formed of the same material that is used in surgery to pack the wire mesh for hernia protection, cement subsequently with the tissue, making it more stable plication.…”

New Minimally Invasive Endoscopic and Surgical Therapies for Gastroesophageal Reflux Disease (GERD)

“…The safety and efficacy of EMR/ESD have been frequently reported and the procedures are now widely applied for BE with high-grade dysplasia (49). In a pilot study, 10 patients with refractory GERD were submitted to ARMS, the results being that EAE and all scores (DeMeester, heartburn, regurgitation) improved, the best results being reported in patients without sliding hernia (50).…”

Transoral Incisionless Fundoplication with "EsopHyX " Device for GERD: Seven Years after Endo Lumenal Fundoplication. World's First Case Report

“…Key words: recurrent GERD, EsophyX Z, redo transoral incisionless fundoplication (TIF 2.0), first worlide case report effects compared to LNF and technically easier to be performed (7,8). All endoscopic, endoluminal techniques improve and augment the LES function, either by thermal therapy (radiofrequency) or by mimicking the antireflux long term well proven fundoplications.…”

“…All endoscopic, endoluminal techniques improve and augment the LES function, either by thermal therapy (radiofrequency) or by mimicking the antireflux long term well proven fundoplications. The new laparoscopic techniques, augment the LES by implanting a magnetic ring around the distal esophagus, or a foreign body comparable to a pacemaker, with two electrodes placed at the LES, stimulating its function (8).…”