Endoscopic therapy for gastroesophageal reflux disease: a systematic review

Endoscopic therapy has emerged as an alternative for patients with symptomatic gastroesophageal reflux disease (GERD) who are seeking a non-pharmacologic, non-surgical intervention. To date, there are 3 basic categories of these endoscopic options: radiofrequency ablation, endoscopic suturing and endoscopic injection. Although the pivotal clinical studies to date have consistently demonstrated efficacy for defined endpoints of symptom control, GERD health related quality of life and discontinuance of acid secretory medications, depending on the therapy, there has been less consistent improvement in objective parameters of pH control and lower esophageal sphincter pressure. Although the data for these procedures has been favorable, extrapolation to justify a more widespread clinical use has been limited by the relative lack of controlled sham studies-although these are currently underway for all of the available therapies. Appropriate patient selection for endoscopic GERD therapy is critical and at present these therapies have the best clinical outcome data in patients who are responsive to therapy with a proton pump inhibitor. The risk/benefit profile, long term durability and cost effectiveness should be considered in all patients being considered when evaluating each of the endoscopic therapies for GERD.