Endoscopic management of gastroesophageal reflux disease: A review

Abstract

Gastroesophageal reflux disease is the most common esophageal disorder encountered in the United States. Gastroesophageal reflux disease symptoms are associated with a negative quality of life and increased healthcare costs and therefore require an effective management strategy. Although proton pump inhibitors remain the primary treatment of gastroesophageal reflux disease, they do not cure the disorder and can leave patients with persistent symptoms despite treatment. Moreover, patients are still at risk of developing such complications as peptic strictures, Barrett's metaplasia, and esophageal cancer. Although laparoscopic Nissen fundoplication has been the conventional alternative treatment for those patients who develop complications of gastroesophageal reflux disease, have intractable symptoms, or wish to discontinue taking proton pump inhibitors, investigators have persisted in developing a number of endoscopic approaches to the treatment of gastroesophageal reflux disease. The present report reviews the history of endoscopic treatments devised for the management of gastroesophageal reflux disease and explores the published data and outcomes associated with the latest approach-endoscopic fundoplication using the EsophyX2 device.

Esophgeal Perforation and Bilateral Empyema Following Endoscopic EsophyX Transoral Incisionless Fundoplication

“…Narsule et al 7 reviewed the development of endoscopic treatment of GERD and summarized the results from more than 20 surgical studies using the EsophyX system in 2012. The patient follow-up in these studies ranged from 2 to 24 months.…”

“…However, other studies have reported serious immediate complications and procedure failures. 7 , 9 , 10 A prospective multicenter trial conducted at seven clinical centers enrolled 86 patients in 2006. 5 The inclusion criterion required chronic GERD treated with PPIs; the exclusion criterion was an irreducible hiatal hernia >2 cm.…”

“…In summary, TIF using the EsophyX device is effective and relatively safe for treating GERD and hiatal hernia <2 cm. 7 , 15 , 16 It promotes esophagitis healing, reduces PPI use, and improves quality of life. However, the complications with this procedure can be serious and life threatening.…”

Ear, nose and throat (ENT) manifestations and complications of reflux

“…Some patients with persistent reflux that fails drug therapy, may be referred for evaluation of surgical management, for example, patients with diagnosed hiatus hernia may benefit from fundoplication. Antireflux surgery (including various forms of fundoplication and devices such as EsophyX and LINX) for GORD presents alternatives and adjuncts to long-term antireflux medication, for those with refractory symptoms 27. There are stringent criteria for such surgery, outside the scope of this paper.…”

“…Endoscopic techniques, such as EsophyX, may be performed by interventional upper GI physicians and are minimally invasive. However, laparoscopic surgery under upper GI surgeons (fundoplication, LINX and others) are thought to have better long-term effectiveness 6 27. These would be used following proof of classic GORD through both OGD and 24 hours pH-impedance testing, but their place in assisting extraoesophageal symptoms alone, as with PPIs, is presently controversial.…”