Endoscopic Treatment of Refractory Gastroesophageal Reflux Disease
The key advantages of endoscopic treatment of refractory gastroesophageal reflux disease are that it is less invasive and has less adverse events. Nissen fundoplication has long been considered the gold standard for antireflux surgery. However, it leads to adverse events such as dysphagia, gas bloating, and inability to belch, and 15–30% of patients require re-intervention after surgery. Currently, there are three categories of currently available endoscopic treatments of refractory gastroesophageal reflux disease: endoscopic devices for ablative therapy, gastric fundoplication, and mucosal resection of the gastroesophageal junction (GEJ) which we introduce in this chapter. Stretta utilizes radiofrequency therapy to improve the lower esophageal sphincter (LES) function. Transoral incisionless fundoplication (TIF) was developed to mimic antireflux surgery by constructing a valve at the GEJ. TIF reconfigures the tissue to obtain a full-thickness gastroesophageal valve from inside the stomach, by serosa-to-serosa plications that include the muscle layers. Mucosectomy was based on the principle that after mucosal resection, mucosal healing results in scar formation.
KeywordsRefractory gastroesophageal reflux disease Radiofrequency therapy Transoral incisionless fundoplication Mucosectomy
- 3.Kalapala R, Shah H, Nabi Z, Darisetty S, Talukdar R, Nageshwar Reddy D. Treatment of gastroesophageal reflux disease using radiofrequency ablation (Stretta procedure): An interim analysis of a randomized trial. Indian J Gastroenterol. 2017;36(5):337–42. https://doi.org/10.1007/s12664-017-0796-7.CrossRefPubMedGoogle Scholar
- 5.Dughera L, Navino M, Cassolino P, De Cento M, Cacciotella L, Cisaro F, et al. Long-term results of radiofrequency energy delivery for the treatment of GERD: results of a prospective 48-month study. Diagn Ther Endosc. 2011;2011:507157. https://doi.org/10.1155/2011/507157.CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Perry KA, Banerjee A, Melvin WS. 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(4):283–8. https://doi.org/10.1097/SLE.0b013e3182582e92.CrossRefPubMedGoogle Scholar
- 8.Trad KS, Fox MA, Simoni G, Shughoury AB, Mavrelis PG, Raza M, et al. Transoral fundoplication offers durable symptom control for chronic GERD: 3-year report from the TEMPO randomized trial with a crossover arm. Surg Endosc. 2017;31(6):2498–508. https://doi.org/10.1007/s00464-016-5252-8.CrossRefPubMedGoogle Scholar
- 10.Zacherl J, Roy-Shapira A, Bonavina L, Bapaye A, Kiesslich R, Schoppmann SF, et al. Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler (MUSE) for gastroesophageal reflux disease: 6-month results from a multi-center prospective trial. Surg Endosc. 2015;29(1):220–9. https://doi.org/10.1007/s00464-014-3731-3.CrossRefPubMedGoogle Scholar