Endoscopic Treatments of GERD

PURPOSE OF REVIEW: Endoscopic therapies for gastroesophageal reflux disease (GERD) are minimally invasive techniques which fill the gap between the medical therapy with proton pump inhibitors (PPIs) and surgical fundoplication. The main endoscopic therapies currently available in the USA are transoral incisionless fundoplication (TIF) using EsophyX device or less commonly, Medigus Ultrasonic Surgical Endostapler, and radiofrequency energy delivery to lower esophageal sphincter using Stretta device. Our aim was to examine the available evidence for these therapies.

Consistent evidence for subjective improvement is available for fundoplication using EsophyX and Stretta, but improvement in objective parameters for GERD is not seen or evaluated in all the studies. There is a reduction in long-term efficacy seen with TIF and also to a lesser extent with Stretta. Endoscopic therapies do not replace surgical fundoplication and therefore are useful in patients with breakthrough symptoms on PPI such as regurgitation or those reluctant to take long-term PPI. An ideal patient is one who has symptoms and objective evidence of GERD such as abnormal pH study or erosive esophagitis without any significant anatomic distortion such as a hiatal hernia. Since these are endoluminal procedures, they do not address the hiatal hernia reduction or repair of crural defect. Adequate training in the technique and careful patient selection are essential prior to embarking on these procedures.