[GERD: endoscopic antireflux therapies].

Area of Science:

• Gastroenterology
• Minimally-invasive surgery

Background:

• Several endoscopic antireflux procedures have been developed, including radiofrequency, biopolymer injection/implantation, and endoscopic suturing.
• Previous techniques like radiofrequency (Stretta) showed modest effects, while implantation (Gatekeeper, Enteryx) faced issues with efficacy or safety.
• First-generation suturing (EndoCinch, ESD) proved the concept but suffered from poor durability due to suture loss.

Purpose of the Study:

• To evaluate the efficacy and durability of a novel transmural plication technique (Plicator) for gastroesophageal reflux disease (GERD).
• To compare the Plicator procedure against a sham procedure in a prospective-randomized trial.

Main Methods:

• A prospective-randomized, sham-controlled trial was conducted.
• The study assessed reflux symptoms, medication requirements, and esophageal acid exposure (24-h-pH-metry) post-procedure.

Main Results:

• The Plicator procedure demonstrated superiority in reducing reflux symptoms compared to the sham procedure.
• Significant improvements were observed in medication use and esophageal acid exposure in the Plicator group.
• The transmural plication technique shows promise for durable GERD management.

Conclusions:

• The Plicator transmural plication technique appears to be a superior endoscopic option for managing GERD compared to sham procedures.
• While long-term data are pending, this technique represents a significant advancement in endoscopic antireflux therapy.
• Further technical innovations are expected to drive progress in endoscopic GERD treatment.