Endoluminal Therapy for Treatment of Gastroesophageal Reflux Disease

Abstract

Gastroesophageal reflux disease (GERD) is a common disorder that is currently treated by medical therapy and surgical or endoscopic transoral interventions. Medical therapy is the most common approach, though concerns have been raised in recent years about the potential side effects of continuous long-term medication, drug intolerance, or unresponsiveness and the need for high dosages for long periods to treat symptoms or prevent recurrences. Surgery too may have consequences such as long-lasting dysphagia, flatulence, inability to belch or vomit, diarrhea, or functional dyspepsia related to delayed gastric emptying. For these reasons in the last 15 years, a variety of transoral endoscopic techniques have been developed as alternatives to antisecretory therapy or antireflux surgery. Endoluminal techniques included three categories (implantation or injection of foreign materials, application of radiofrequency ablation, and endoscopic tissue apposition techniques) and showed significant symptom control in the short-term period in the majority of published studies. However, most of them had disappointing long-term results or did not demonstrate long-lasting benefits and have been abandoned. In the last years, transoral incisionless fundoplication has been shown to be an effective and promising therapeutic option, allowing endoscopists to bring the surgical principles of an anterior partial fundoplication to patients with fewer post-fundoplication complications than surgery. Two FDA-approved endoluminal platforms are currently available, namely, the EsophyX^® device and the MUSE™ system: improvement of GERD symptoms up to 6 years, cessation or reduction of proton pump inhibitor medication in about 75 % of patients, and improvement of functional findings, measured by either pH or impedance monitoring, have been shown with these techniques.