Advanced Endoscopic Imaging and Interventions in GERD: An Update and Future Directions

Abstract

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases encountered in primary care and gastroenterology clinics. Most cases of GERD can be diagnosed based on clinical presentation and risk factors; however, some patients present with atypical symptoms, which can make diagnosis difficult. An esophagogastroduodenoscopy can be used to assist in diagnosis of GERD, though only half of these patients have visible endoscopic findings on standard white light endoscopy. This led to the development of new advanced endoscopic techniques that enhanced the diagnosis of GERD and related complications like squamous cell dysplasia, Barrett's esophagus, and early esophageal adenocarcinoma. This is conducted by improved detection of subtle irregularities in the mucosa and vascular structures through optical biopsies in real-time. Management of GERD includes lifestyle modifications, pharmacological therapy, endoscopic and surgical intervention. Minimally invasive endoscopic intervention can be an option in selected patients with small hiatal hernia and without complications of GERD. These endoscopic interventions include endoscopic fundoplication, endoscopic mucosal resection techniques, ablative techniques, creating mechanical barriers, and suturing and stapling devices. As these new advanced endoscopic techniques are emerging, data surrounding the indications, advantages and disadvantages of these techniques need a thorough understanding.

Updates on Surgical Treatment for Gastroesophageal Reflux Disease

“…Multiple agents have been created for this and include Enteryx®, Durasphere®, Gatekeeper™, and Plexiglas. 75 Adverse events including death led to the removal of Enteryx® from the market. 75,76 Despite these agents showing positive results for the treatment of GERD, there is insufficient data to recommend these agents currently.…”

Endoscopy without Sedation less Time in the Recovery Unit Post-Procedure

“…Nevertheless, it is also feasible to perform the procedure in alternative medical environments such as the emergency department, intensive care unit, or operating room by utilizing portable endoscopy carts. Various types of equipment and endoscopes are employed to carry out supplementary procedures such as Endoscopic Ultrasonography (EUS), Endoscopic Retrograde Cholangiopancreatography (ERCP), and small-bowel endoscopy [12].…”

Role of endoscopy in gastroesophageal reflux disease

“…The procedure reduces the transient lower esophageal sphincter relaxation rate, bolsters the EGJ, and prevents proximal migration of gastroesophageal reflux in the esophagus. 41 Stretta is safe and effective for the treatment of GERD, with a significant improvement in GERD health-related quality of life (GERD-HRQL), heartburn symptoms, healing of EE, and reduction of esophageal acid exposure. 42 Transoral incisionless fundoplication TIF (EsophyX2 device) is a technique that reconstructs the lower esophageal sphincter to restore the angle of His and thus augments the gastroesophageal flap valve (Fig.…”