Endoscopic Approaches to the Treatment of GERD

  • Mike ThomsonEmail author


Gastroesophageal reflux treatment aims to achieve symptom relief while preventing complications. Patients who fail to achieve control with medical therapy, have persistent severe esophagitis or become long-term dependent on anti-reflux treatments may have an anti-reflux procedure indicated [1]. The principle of surgery in gastroesophageal reflux disease is to form some kind of reconstruction of the anti-reflux barrier, although exactly how efficacy is achieved is not fully understood. Open Nissen’s fundoplication has been the treatment of choice to date, but this is invasive and associated with a degree of morbidity and mortality. In recent years laparoscopic fundoplication has become popular and, in general, has replaced the open Nissen’s procedure—equal, though not superior, efficacy and safety have been demonstrated. However, with the laparoscopic procedure, cosmesis is clearly superior and in adult studies complications appear less common, with good success rates. It could be argued therefore that there remains little or no place for open anti-reflux procedures in paediatrics.

Three general endoscopic techniques have been devised and used for the treatment of GERD and have received extensive attention in adult studies and limited scrutiny in paediatric series. These are described below.


Children Endoscopy Gastro-oesophageal reflux Fundoplication Esophyx Stretta 


  1. 1.
    Vandenplas Y, Rudolph C, Di Lorenzo C, Hassall E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of NASPGHAN and ESPGHAN. J Pediatr Gastroenterol Nutr. 2009;49(4):498–547.CrossRefPubMedGoogle Scholar
  2. 2.
    Thomson M, et al. Endoluminal gastroplication in children with significant gastro-oesophageal reflux disease. Gut. 2004;53:1745–50.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Thomson M, et al. Medium-term outcome of endoluminal gastroplication with the Endocinch device in children. J Pediatr Gastroenterol Nutr. 2008;46:172–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Pleskow D, et al. Endoscopic full-thickness plication for the treatment of GERD: a multicenter trial. Gastrointest Endosc. 2004;59:163–71.CrossRefPubMedGoogle Scholar
  5. 5.
    Cadiere G, Buset M, Muls V, Rajan A, Rosch T, Eckardt AJ, et al. Antireflux transoral incisionless fundoplication using EsophyX: 12-month results of a prospective multicenter study. World J Surg. 2008;32:1676–88.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Cadiềre G-B, van Sante N, Graves J, Gawlicka A, Rajan A. Two year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX. Surg Endosc. 2009;23(5):957–64.CrossRefPubMedGoogle Scholar
  7. 7.
    Repici A, Fumagalli U, Malesci A, Barbera R, Gambaro C, Rosati R. Endoluminal fundoplication (ELF) for GERD using EsophyX: a 12-month follow-up in a single-center experience. J Gastrointest Surg. 2010;14(1):1–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Testoni PA, Vailati C. Transoral incision less fundoplication with EsophyX® for treatment of gastro-oesphageal reflux disease. Dig Liver Dis. 2012;44(8):631–5.CrossRefPubMedGoogle Scholar
  9. 9.
    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(8):2323–33.CrossRefPubMedGoogle Scholar
  10. 10.
    Chen S, Jarboe M, Teitelbaum D. Effectiveness of a transluminal endoscopic fundoplication for the treatment of pediatric gastroesophageal reflux disease. Pediatr Surg Int. 2012;28(3):229–34.CrossRefPubMedGoogle Scholar
  11. 11.
    Thomson M. Endoscopic approaches to the treatment of GERD. J Pediatr Gastroenterol Nutr. 2011;53(Suppl 2):S11–3.PubMedGoogle Scholar
  12. 12.
    Reymunde S, Santiago N. Long term results of radio-frequency energy delivery for the treatment of GERD: sustained improvements in symptoms, quality of life, and drug use at 4-year follow up. Gastrointest Endosc. 2007;65:361–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Perry K, Banerjee A, Melvin W. 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;22:283–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Endoscopic radiofrequency ablation for gastrooesophageal reflux disease. Interventional procedure guidance. Published: 28 August 2013.
  15. 15.
    Islam S, Geiger J, Coran A, Teitelbaum D. Use of radiofrequency ablation of the lower esophageal sphincter to treat recurrent gastroesophageal reflux disease. J Pediatr Surg. 2004;39:282–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Liu DC, et al. Stretta as the initial antireflux procedure in children. J Pediatr Surg. 2005;40:148–51.CrossRefPubMedGoogle Scholar
  17. 17.
    Cohen L, et al. Enteryx implantation for GERD: expanded multicenter trial results and interim post-approval follow-up to 24 months. Gastrointest Endosc. 2005;61:650–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Sheffield Children’s HospitalSheffieldUK

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