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Minimally Invasive GERD Therapies

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Diagnosis and Treatment of Gastroesophageal Reflux Disease

Abstract

Studies show that although approximately 30–40 % of patients with gastroesophageal reflux disease (GERD) fail to respond symptomatically to aggressive acid suppressive therapy with proton pump inhibitors (PPI), less than 5 % of them undergo fundoplication. Patients who have persistent GERD symptoms despite medical therapy and are not willing to undergo fundoplication fall into what is called the GERD treatment gap. Newer minimally invasive techniques, both endoscopic and laparoscopic, have been introduced to address this gap and include gastric bypass surgery for the obese patient with GERD.

Exciting new devices and endoscopic as well as laparoscopic techniques have been introduced and are actively and increasingly used in this patient population. The advantage of these procedures is that they do not dramatically alter the anatomy of the esophagogastric junction, esophagus, or stomach, and thus they have a better side-effect profile. This chapter provides an overview of these novel therapies as well as our proposed algorithm on the management of refractory GERD, mostly based on the presence of an underlying sliding hiatal hernia and the degree of symptomatic response to previous interventions. The therapies presented include endoscopic therapies (Stretta; transoral fundoplication; Medigus Ultrasonic Surgical Endostapler (MUSE™) system; and anti-reflux mucosectomy) as well as novel laparoscopic treatments (LINX; EndoStim) and, lastly, laparoscopic Roux-en-Y gastric bypass for the obese patient with GERD.

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Author information

Authors and Affiliations

  1. Department of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Dan E. Azagury MD

  2. Department of Medicine, Stanford University, 300 Pasteur Drive; MC: 5187, 94305, Stanford, CA, USA

    George Triadafilopoulos MD, DSc

Authors
  1. Dan E. Azagury MD
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  2. George Triadafilopoulos MD, DSc
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Correspondence to George Triadafilopoulos MD, DSc .

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Editors and Affiliations

  1. Department of Gastroenterology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

    Michael F. Vaezi

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Azagury, D., Triadafilopoulos, G. (2016). Minimally Invasive GERD Therapies. In: Vaezi, M. (eds) Diagnosis and Treatment of Gastroesophageal Reflux Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-19524-7_7

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  • DOI: https://doi.org/10.1007/978-3-319-19524-7_7

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