Novel minimal invasive antireflux techniques: A systematic review

New transoral and minimally invasive techniques for the treatment of gastroesophageal reflux disease (GERD) have emerged, warranting evaluation of their clinical efficacy and safety.

A literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Based on the available amount of information about clinical efficacy, the review was restricted to Stretta, Esophyx/TIF, MUSE (Medigus ultrasonic surgical endostapler), LINX, and RefluxStop procedures.

In total, 86 original studies evaluating the efficacy and safety of second-generation antireflux techniques were identified. The study populations are well described in which GERD is objectively verified. For Stretta, data were available from four double-blind, sham-controlled, randomized studies (RCT) albeit with a short follow-up time. Cohort-based data on 24-h pH monitoring, proton pump inhibitor (PPI) consumption, and QoL demonstrated a clinically significant long-term effect. For the Esophyx technique, two double-blind, sham-controlled randomized studies with 12 months of follow-up are available, which together with prospective cohort studies with longer follow-up demonstrate a sustained effect. The corresponding long-term effects of MUSE transoral technique need to be defined. The scientific documentation behind the LINX technique is incomplete, but data show the same level of efficacy in terms of objective assessments as for Esophyx. The scientific evidence for RefluxStop is still meager but promising.

Both Esophyx and LINX seem to provide long-lasting symptom control with normalization of QoL in patients with chronic GERD. This seems to be true for patients with small hiatal hernia who responded well to treatment with PPI. MUSE and RefluxStop™ need better documentation to define their future role in clinical practice.