Endoscopic treatment modalities for gastroesophageal reflux disease

Abstract

A debate has been going for decades between surgeons and gastroenterologists about the treatment of choice for gastroesophageal reflux disease (GERD). The lower esophageal sphincter (LES) has been historically far from the reach of gastroenterologists, who adopted the symptomatic treatment as their approach to reflux disease through reduction of gastric acid. As for surgeons, reaching the LES was only possible by invading the thoracic or abdominal cavity. Although their approach was later refined to become "minimally" invasive, it was still deemed too invasive by others to allow it to be the "gold standard." Simple logic should lead one to think about the "natural route" as the easiest way to reach the LES. This concept has opened the door for the new era of GERD treatment through "endoscopic modality." Seven different techniques are currently being used to treat patients with GERD. We review the mechanism of action, potential side effects, efficacy, durability, and results from the most recent or largest experience of each. This review shows that endoscopic treatment has definitely earned its place as a viable option for GERD treatment in selected patients. With the available data from clinical trials, it is not possible to determine the best modality available, and the endoscopic treatment of choice is to be determined with further studies.

Patient factors predictive of 24-h pH normalization following endoluminal gastroplication for GERD

“…Acid suppression medicines or laparoscopic antireflux surgery (ARS) are currently the standard treatment for GERD [4,5]. Over the past decade, a number of flexible endoscopic techniques have emerged as alternatives to laparoscopic ARS to provide GERD symptom relief and reduce medication dependency [6,7] in the treatment of GERD. One such procedure involves restructuring of the gastric cardia using a transmural suture to create an improved barrier to gastroesophageal reflux (Plicator TM ; NDO Surgical, Inc., Mansfield, MA).…”

Endoluminal and transluminal surgery: current status and future possibilities

“…The average procedure time is less than 20 min. The GERD symptoms are improved by restoring the val- [20] reported one esophageal perforation c One death reported by CDRH due to injection into the aorta; another report of renal failure due to embolization d Esophageal perforation related to introduction of overtube in one patient e Most adverse effects are transient, one report of self-limited bleeding [39] vular mechanism of the GE junction, altering the angle of His, and reducing compliance of the cardia and fundus [15].…”

Gastroesophageal Reflux Disease (GERD): An Overview of Current Minimal-Invasive Treatment Potentials

“…Lutfi et al [60] concluded in their review article on endoscopic GERD treatments, that injection of PMMA is attractive in its simplicity and ease. They mention that the viscosity of the material can cause a technical challenge when injected through a long needle or catheter.…”