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Endoluminal Therapy for Gastroesophageal Reflux Disease: In Between the Pill and the Knife?

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Abstract

Gastroesophageal reflux disease (GERD) is a chronic disease characterized by symptoms of heartburn and acid regurgitation. Uncontrolled GERD can significantly impact quality of life, can lead to complications, and increases the risk of esophageal cancer. Over the past few decades, there has been an increasing prevalence of GERD among adults in Western populations. The use of proton pump inhibitors (PPI) in conjunction with lifestyle modifications remains the mainstay therapy. However, the efficacy of this intervention is often hampered by adherence, costs, and the risks of long-term PPI use. Anti-reflux surgery is an option for patients with refractory symptoms or in those in whom medical therapy is contraindicated or not desirable. While conventional surgery has an acceptable safety profile, there has been an increasing interest in alternate treatments that may potentially offer similar results and be associated with a faster recovery. Recent advances in interventional endoluminal techniques have introduced novel incisionless anti-reflux procedures. While the current data are promising, further larger prospective studies are needed in order to assess the long-term efficacy of endoluminal therapies and its place among the treatment options for GERD.

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Fig. 1

Images adapted with permission from Hunter et al. [44]

Fig. 2

Images courtesy of Medigus Israel, Omer 84965, Israel

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Abbreviations

GERD:

Gastroesophageal reflux disease

PPI:

Proton pump inhibitors

GEJ:

Gastroesophageal junction

LES:

Lower esophageal sphincter

TLESRs:

Transient LES relaxations

RCTs:

Randomized clinical trials

LF:

Laparoscopic fundoplication

MSA:

Magnetic sphincter augmentation

LES:

Lower esophageal sphincter

HRQL:

Health-related quality of life

TIF:

Transoral incisionless fundoplication

MUSE™:

Medigus Ultrasonic Surgical Endostapler

RFA:

Radiofrequency ablation

References

  1. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63:871–880.

    Article  PubMed  Google Scholar 

  2. Wang R, Zou D, Ma X, et al. Impact of gastroesophageal reflux disease on daily life: the Systematic Investigation of Gastrointestinal Diseases in China (SILC) epidemiological study. Health Qual Life Outcomes. 2010;8:128.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Perry KA, Banerjee A, Melvin WS. Radiofrequency energy delivery to the lower esophageal sphincter reduces esophageal acid exposure and improves GERD symptoms: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech. 2012;22:283–288.

    Article  PubMed  Google Scholar 

  4. Friedenberg FK, Hanlon A, Vanar V, et al. Trends in gastroesophageal reflux disease as measured by the National Ambulatory Medical Care Survey. Dig Dis Sci. 2010;55:1911–1917.

    Article  PubMed  Google Scholar 

  5. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143:1179-87.e1–1179-87.e3.

    Article  Google Scholar 

  6. Gross M, Beckenbauer U, Burkowitz J, Walther H, Brueggenjuergen B. Impact of gastro-oesophageal reflux disease on work productivity despite therapy with proton pump inhibitors in Germany. Eur J Med Res. 2010;15:124–130.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Wahlqvist P, Reilly MC, Barkun A. Systematic review: the impact of gastro-oesophageal reflux disease on work productivity. Aliment Pharmacol Ther. 2006;24:259–272.

    Article  CAS  PubMed  Google Scholar 

  8. Edgren G, Adami HO, Weiderpass E, Weiderpass Vainio E, Nyrén O. A global assessment of the oesophageal adenocarcinoma epidemic. Gut. 2013;62:1406–1414.

    Article  PubMed  Google Scholar 

  9. Boeckxstaens G, El-Serag HB, Smout AJ, Kahrilas PJ. Symptomatic reflux disease: the present, the past and the future. Gut. 2014;63:1185–1193.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cameron AJ. Barrett’s esophagus: prevalence and size of hiatal hernia. Am J Gastroenterol. 1999;94:2054–2059.

    Article  CAS  PubMed  Google Scholar 

  11. Corleto VD, Festa S, Di Giulio E, Annibale B. Proton pump inhibitor therapy and potential long-term harm. Curr Opin Endocrinol Diabetes Obes. 2014;21:3–8.

    Article  CAS  PubMed  Google Scholar 

  12. Savarino V, Dulbecco P, Savarino E. Are proton pump inhibitors really so dangerous? Dig Liver Dis. 2016;48:851–859.

    Article  CAS  PubMed  Google Scholar 

  13. Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2016;14:175-82.e3.

    Google Scholar 

  14. Maradey-Romero C, Kale H, Fass R. Nonmedical therapeutic strategies for nonerosive reflux disease. J Clin Gastroenterol. 2014;48:584–589.

    Article  PubMed  Google Scholar 

  15. Huggins S. The role of gastroesophageal reflux disease in asthma. J Am Acad Nurse Pract. 2008;20:238–242.

    Article  PubMed  Google Scholar 

  16. Salminen P, Hurme S, Ovaska J. Fifteen-year outcome of laparoscopic and open Nissen fundoplication: a randomized clinical trial. Ann Thorac Surg. 2012;93:228–233.

    Article  PubMed  Google Scholar 

  17. Mark LA, Okrainec A, Ferri LE, Feldman LS, Mayrand S, Fried GM. Comparison of patient-centered outcomes after laparoscopic Nissen fundoplication for gastroesophageal reflux disease or paraesophageal hernia. Surg Endosc. 2008;22:343–347.

    Article  PubMed  Google Scholar 

  18. Broeders JA, Draaisma WA, Rijnhart-de Jong HG, et al. Impact of surgeon experience on 5-year outcome of laparoscopic Nissen fundoplication. Arch Surg. 2011;146:340–346.

    Article  PubMed  Google Scholar 

  19. Vignal JC, Luc G, Wagner T, Cunha AS, Collet D. Re-operation for failed gastro-esophageal fundoplication. What results to expect? J Visc Surg. 2012;149:e61-5.

    Article  PubMed  Google Scholar 

  20. Zhang H, Dong D, Liu Z, He S, Hu L, Lv Y. Revaluation of the efficacy of magnetic sphincter augmentation for treating gastroesophageal reflux disease. Surg Endosc. 2016;30:3684–3690.

    Article  PubMed  Google Scholar 

  21. Pandolfino JE, Krishnan K. Do endoscopic antireflux procedures fit in the current treatment paradigm of gastroesophageal reflux disease? Clin Gastroenterol Hepatol. 2014;12:544–554.

    Article  PubMed  Google Scholar 

  22. Hopkins J, Switzer NJ, Karmali S. Update on novel endoscopic therapies to treat gastroesophageal reflux disease: a review. World J Gastrointest Endosc. 2015;7:1039–1044.

    PubMed  PubMed Central  Google Scholar 

  23. O’Connor KW, Lehman GA. Endoscopic placement of collagen at the lower esophageal sphincter to inhibit gastroesophageal reflux: a pilot study of 10 medically intractable patients. Gastrointest Endosc. 1988;34:106–112.

    Article  PubMed  Google Scholar 

  24. Fockens P, Cohen L, Edmundowicz SA, et al. Prospective randomized controlled trial of an injectable esophageal prosthesis versus a sham procedure for endoscopic treatment of gastroesophageal reflux disease. Surg Endosc. 2010;24:1387–1397.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Feretis C, Benakis P, Dimopoulos C, et al. Endoscopic implantation of Plexiglas (PMMA) microspheres for the treatment of GERD. Gastrointest Endosc. 2001;53:423–426.

    Article  CAS  PubMed  Google Scholar 

  26. Fornari F, Freitag CP, Duarte ME, et al. Endoscopic augmentation of the esophagogastric junction with polymethylmethacrylate: durability, safety, and efficacy after 6 months in mini-pigs. Surg Endosc. 2009;23:2430–2437.

    Article  PubMed  Google Scholar 

  27. Kamler JP, Lemperle G, Lemperle S, Lehman GA. Endoscopic lower esophageal sphincter bulking for the treatment of GERD: safety evaluation of injectable polymethylmethacrylate microspheres in miniature swine. Gastrointest Endosc. 2010;72:337–342.

    Article  PubMed  Google Scholar 

  28. Ganz RA, Fallon E, Wittchow T, Klein D. A new injectable agent for the treatment of GERD: results of the Durasphere pilot trial. Gastrointest Endosc. 2009;69:318–323.

    Article  PubMed  Google Scholar 

  29. Muthusamy VR, Lightdale JR, Acosta RD, et al. The role of endoscopy in the management of GERD. Gastrointest Endosc. 2015;81:1305–1310.

    Article  PubMed  Google Scholar 

  30. Kahrilas PJ. Radiofrequency energy treatment of GERD. Gastroenterology. 2003;125:970–973.

    Article  PubMed  Google Scholar 

  31. Coron E, Sebille V, Cadiot G, et al. Clinical trial: radiofrequency energy delivery in proton pump inhibitor-dependent gastro-oesophageal reflux disease patients. Aliment Pharmacol Ther. 2008;28:1147–1158.

    Article  CAS  PubMed  Google Scholar 

  32. Triadafilopoulos G. Stretta: a valuable endoscopic treatment modality for gastroesophageal reflux disease. World J Gastroenterol. 2014;20:7730–7738.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Corley DA, Katz P, Wo JM, et al. Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial. Gastroenterology. 2003;125:668–676.

    Article  PubMed  Google Scholar 

  34. Aziz AM, El-Khayat HR, Sadek A, et al. A prospective randomized trial of sham, single-dose Stretta, and double-dose Stretta for the treatment of gastroesophageal reflux disease. Surg Endosc. 2010;24:818–825.

    Article  PubMed  Google Scholar 

  35. Arts J, Bisschops R, Blondeau K, et al. A double-blind sham-controlled study of the effect of radiofrequency energy on symptoms and distensibility of the gastro-esophageal junction in GERD. Am J Gastroenterol. 2012;107:222–230.

    Article  CAS  PubMed  Google Scholar 

  36. Liang WT, Wu JM, Wang F, Hu ZW, Wang ZG. Stretta radiofrequency for gastroesophageal reflux disease-related respiratory symptoms: a prospective 5-year study. Minerva Chir. 2014;69:293–299.

    CAS  PubMed  Google Scholar 

  37. Dughera L, Rotondano G, De Cento M, Cassolino P, Cisarò F. Durability of Stretta radiofrequency treatment for GERD: results of an 8-year follow-up. Gastroenterol Res Pract. 2014;2014:531907.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Noar M, Squires P, Noar E, Lee M. Long-term maintenance effect of radiofrequency energy delivery for refractory GERD: a decade later. Surg Endosc. 2014;28:2323–2333.

    Article  PubMed  Google Scholar 

  39. Lipka S, Kumar A, Richter JE. No evidence for efficacy of radiofrequency ablation for treatment of gastroesophageal reflux disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2015;13:1058-67.e1.

    Article  PubMed  Google Scholar 

  40. Richardson WS, Stefanidis D, Fanelli RD. Society of American Gastrointestinal and Endoscopic Surgeons Response to “No evidence for efficacy of radiofrequency ablation for treatment of gastroesophageal reflux disease: a systematic review and meta-analysis”. Clin Gastroenterol Hepatol. 2015;13:1700–1701.

    Article  PubMed  Google Scholar 

  41. Locke GR, Horwhat J, Mashimo H, et al. Endotherapy for and tailored approaches to treating GERD, and refractory GERD. Ann N Y Acad Sci. 2013;1300:166–186.

    Article  CAS  PubMed  Google Scholar 

  42. Cadière GB, Rajan A, Rqibate M, et al. Endoluminal fundoplication (ELF)–evolution of EsophyX, a new surgical device for transoral surgery. Minim Invasive Ther Allied Technol. 2006;15:348–355.

    Article  PubMed  Google Scholar 

  43. Svoboda P, Kantorová I, Kozumplík L, et al. Our experience with transoral incisionless plication of gastroesophageal reflux disease: NOTES procedure. Hepatogastroenterology. 2011;58:1208–1213.

    Article  PubMed  Google Scholar 

  44. Hunter JG, Kahrilas PJ, Bell RC, et al. Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology. 2015;148:324-33.e5.

    Article  Google Scholar 

  45. Trad KS, Barnes WE, Simoni G, et al. Transoral incisionless fundoplication effective in eliminating GERD symptoms in partial responders to proton pump inhibitor therapy at 6 months: the TEMPO Randomized Clinical Trial. Surg Innov. 2015;22:26–40.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Witteman BP, Conchillo JM, Rinsma NF, et al. Randomized controlled trial of transoral incisionless fundoplication vs. proton pump inhibitors for treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2015;110:531–542.

    Article  CAS  PubMed  Google Scholar 

  47. Håkansson B, Montgomery M, Cadiere GB, et al. Randomised clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD. Aliment Pharmacol Ther. 2015;42:1261–1270.

    Article  PubMed  Google Scholar 

  48. Bell RC, Barnes WE, Carter BJ, et al. Transoral incisionless fundoplication: 2-year results from the prospective multicenter U.S. study. Am Surg. 2014;80:1093–1105.

    PubMed  Google Scholar 

  49. Testoni PA, Testoni S, Mazzoleni G, Vailati C, Passaretti S. Long-term efficacy of transoral incisionless fundoplication with Esophyx (Tif 2.0) and factors affecting outcomes in GERD patients followed for up to 6 years: a prospective single-center study. Surg Endosc. 2015;29:2770–2780.

    Article  PubMed  Google Scholar 

  50. Kim HJ, Kwon CI, Kessler WR, Selzer DJ, McNulty G, Bapaye A, et al. Long-term follow-up results of endoscopic treatment of gastroesophageal reflux disease with the MUSE™ endoscopic stapling device. Surg Endosc. 2016;30:3402–3408.

    Article  PubMed  Google Scholar 

  51. Zacherl J, Roy-Shapira A, Bonavina L, et al. Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler (MUSE™) for gastroesophageal reflux disease: 6-month results from a multi-center prospective trial. Surg Endosc. 2015;29:220–229.

    Article  PubMed  Google Scholar 

  52. Lo WK, Mashimo H. Critical assessment of endoscopic techniques for gastroesophageal reflux disease. J Clin Gastroenterol. 2015;49:720–724.

    Article  PubMed  Google Scholar 

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Authors’ contributions

Brar TS performed literature search, and designed and drafted the article. Yang D performed literature search, and designed and revised the article. All authors were involved in the critical review and final approval of the article.

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Authors and Affiliations

  1. Department of Medicine, University of Florida, Gainesville, FL, USA

    Tony S. Brar

  2. Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 1329 SW 16th Street, Room #5251, Gainesville, FL, 32608, USA

    Peter V. Draganov & Dennis Yang

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Correspondence to Dennis Yang.

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Brar, T.S., Draganov, P.V. & Yang, D. Endoluminal Therapy for Gastroesophageal Reflux Disease: In Between the Pill and the Knife?. Dig Dis Sci 62, 16–25 (2017). https://doi.org/10.1007/s10620-016-4355-3

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