Endoscopic Anti-Reflux Procedures: Ready for Clinical Use?

Endoscopic intervention is one of the therapeutic modalities that are currently available for GERD. Endoscopic treatment for GERD has been recently positioned as an alternative for chronic medical therapy or anti-reflux surgery. Patients who are candidates for these procedures include those with typical symptoms of GERD, low-grade erosive esophagitis (Los Angeles A and B), abnormal esophageal acid exposure if normal endoscopy, small hiatal hernia (< 3 cm), and partial or complete response to PPI treatment. This review will highlight the present and emerging data available about current and new endoscopic therapeutic modalities for GERD.

Presently, there are three endoscopic techniques that are approved for GERD, including the Stretta procedure, transoral incisionless fundoplication (TIF), and Medigus ultrasonic surgical endostapler (MUSE). Overall, all endoscopic techniques for GERD have reported excellent control of GERD-related symptoms, improvement of health-related quality of life, durability, and safety. However, the quality of evidence to support these claims varies greatly from one procedure to the other. Furthermore, there is an important discrepancy between improvement of subjective clinical parameters versus objective clinical parameters. There is a growing interest in positioning the endoscopic techniques in patient’s post-bariatric surgery, after peroral endoscopic myotomy (POEM), and in those who also require hiatal hernia repair. There are several new endoscopic interventions for GERD that are currently under investigation.

Endoscopic techniques are currently part of our therapeutic armamentarium for GERD. Criticism about their limited effect on objective clinical endpoints has tempered the enthusiasm of patients and physicians alike about their therapeutic value. However, endoscopic therapy for GERD is here to stay as more patients are looking for alternatives to medical and surgical therapy.