Endoscopic Therapy for GERD

Abstract

As alternative to medical treatment and surgical fundoplication, endoscopic treatments for GERD have been developed and are available for selected patients. Endoscopic anti-reflux therapy (EART) can be evaluated after failure of treatment with PPI. This mainly includes patients with persistent symptoms and acid reflux despite high-dose PPI therapy. In rare circumstances, patients, who do not tolerate a PPI therapy because of side-effects, may be candidates for EART as well. Mandatory examinations prior to EART include an upper GI endoscopy, 24-hour pH monitoring and a high-resolution manometry of the esophagus. The currently available EARTs are based upon either full-thickness tissue plication at the gastroesophageal junction, radiofrequency ablation, or endoscopic mucosal resection. An endoscopic full-thickness plication with serosa-to-serosa apposition at the cardia is the endoscopic technique that comes closest to surgical fundoplication. Different systems to perform the endoscopic full-thickness plication are currently available such as the GERDX device, the MUSE, and the EsophyX device. In one-third of patients acid suppression therapy can be discontinued after EART, in one-third an on-demand therapy is sufficient, and the last third will either require long-term medical treatment or surgery due to persistent acid reflux and symptoms.