Endoscopic Approaches to the Treatment of GERD

Abstract

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.