Endoscopic Treatment for Gastroesophageal Reflux Disease

Gastroesophageal reflux disease is a common illness that requires continuous and potentially long-term therapy. Current therapies include long-term acid-reducing medications (most commonly proton pump inhibitors), laparoscopic and open antireflux surgery, and most recently, endoscopic therapies. For the majority of patients with symptomatic GERD, long-term acid-reduction medications are standard therapy. However, endoscopic therapies offer an exciting new avenue for both research and clinical application in persons with gastroesophageal reflux disease. The role of endoscopic therapy in the management of patients with gastroesophageal reflux is still unclear at this time. Its major advantage will be for patients who do not desire long-term medical therapy, particularly those who are on fixed incomes and do not have prescription coverage. The mechanisms by which endoscopic antireflux treatment is effective at this time are uncertain at this time but likely involve a decrease in transient lower esophageal sphincter relaxations that result in decreased acid reflux and potentially in reduced acid sensory stimulation. The anticipated benefits from endoscopic therapy are discontinuance of medications in 30% to 50% of patients at 2 years posttreatment, a reduction in medication use in another 10% to 15% of patients, and avoidance of disruption of the antireflux barrier. The long-term durability of endoscopic treatment is still unknown, although 2-year data appear promising. The role of endoscopic therapy in the treatment of patients with modest hiatal hernias, delayed gastric emptying, atypical symptoms of gastroesophageal reflux, and failed Nissen fundoplication with documented postprocedure reflux remains unclear and requires further study.