Abstract
As alternative to medical treatment and surgical fundoplication, endoscopic treatments for GERD have been developed and are available for selected patients. Endoscopic anti-reflux therapy (EART) can be evaluated after failure of treatment with PPI. This mainly includes patients with persistent symptoms and acid reflux despite high-dose PPI therapy. In rare circumstances, patients, who do not tolerate a PPI therapy because of side-effects, may be candidates for EART as well. Mandatory examinations prior to EART include an upper GI endoscopy, 24-hour pH monitoring and a high-resolution manometry of the esophagus. The currently available EARTs are based upon either full-thickness tissue plication at the gastroesophageal junction, radiofrequency ablation, or endoscopic mucosal resection.
An endoscopic full-thickness plication with serosa-to-serosa apposition at the cardia is the endoscopic technique that comes closest to surgical fundoplication. Different systems to perform the endoscopic full-thickness plication are currently available such as the GERDX device, the MUSE, and the EsophyX device. In one-third of patients acid suppression therapy can be discontinued after EART, in one-third an on-demand therapy is sufficient, and the last third will either require long-term medical treatment or surgery due to persistent acid reflux and symptoms.
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Wannhoff, A., Caca, K. (2020). Endoscopic Therapy for GERD. In: Horgan, S., Fuchs, KH. (eds) Management of Gastroesophageal Reflux Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-48009-7_6
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