Skip to main content

Advertisement

Log in

Endoscopic therapy for GERD: Does it have a future?

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Approximately 20% of patients with gastroesophageal reflux disease (GERD) have symptoms refractory to long-term proton pump inhibitor (PPI) therapy. Furthermore, PPI therapy is expensive. Fundoplication is considered the gold standard of GERD therapy in terms of normalization of esophageal acid exposure and symptom control; however, this exposes the patient to the risks of surgery and anesthesia. Therefore, an endoscopic approach to treating GERD that obviates the need for PPIs and avoids surgical morbidity is desirable. Several endoscopic methods have been used, including radiofrequency ablation, implantation of foreign substances as bulking agents, and various tissue apposition strategies. The emerging field of GERD endotherapy is promising, but more rigorous, sham-controlled, long-term studies are required to elucidate its exact role in clinical practice. This review discusses the evolution of these concepts, describes specific endoscopic devices that have been developed, and explores the future of endotherapies as viable treatment alternatives for GERD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Locke GR, Talley NJ, Fett SL, et al.: Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 1997, 112:1448–1456.

    Article  PubMed  Google Scholar 

  2. McDougall NI, Johnston BT, Collins JS, et al.: Disease progression in gastro-oesophageal reflux disease, as determined by repeat oesophageal pH monitoring and endoscopy, 3 to 4.5 years after diagnosis. Eur J Gastroenterol Hepatol 1997, 9:1161–1167.

    PubMed  CAS  Google Scholar 

  3. Kamolz T, Pointner R, Velanovich V: The impact of gastroesophageal reflux disease on quality of life. Surg Endosc 2003, 17:1193–1199.

    Article  PubMed  CAS  Google Scholar 

  4. Miller L, Vegesna A, Kalra A, et al.: New observations on the gastroesophageal antireflux barrier. Gastroenterol Clin North Am 2007, 36:601–617.

    Article  PubMed  Google Scholar 

  5. Stein HJ, DeMeester TR, Naspetti R, et al.: Three-dimensional imaging of the LES in gastroesophageal reflux disease. Ann Surg 1991, 214:374–384.

    Article  PubMed  CAS  Google Scholar 

  6. Mittal RK, Holloway R, Panagini R, et al.: Transient lower esophageal sphincter relaxation. Gastroenterology 1995, 109:601–606.

    Article  PubMed  CAS  Google Scholar 

  7. Kalra A, Vegesna AK, Besetty R, et al.: Induced transient lower esophageal sphincter relaxation (TLESR) in normal control subjects and in patients with hiatal hernia. Gastroenterology 2008 (in press).

  8. Triadafilopoulos G: Endotherapy and surgery for GERD. J Clin Gastroenterol 2007, 41:S87–S96.

    Article  PubMed  Google Scholar 

  9. Yang YX, Lewis JD, Epstein S, et al.: Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 2006, 296:2947–2953.

    Article  PubMed  CAS  Google Scholar 

  10. Gerson LB, Boparai V, Ullah N, et al.: Oesophageal and gastric pH profiles in patients with gastro-oesophageal reflux disease and Barrett’s oesophagus treated with proton pump inhibitors. Aliment Pharmacol Ther 2004, 20:637–643.

    Article  PubMed  CAS  Google Scholar 

  11. Dominitz JA, Dire CA, Billingsley KG, et al.: Complications and anti-reflux medication use after antireflux surgery. Clin Gastroenterol Hepatol 2006, 4:299–305.

    Article  PubMed  Google Scholar 

  12. Hatch KF, Daily MF, Christiansen BJ, et al.: Failed fundoplication. Am J Surg 2004, 188:786–791.

    Article  PubMed  Google Scholar 

  13. Lehman GA, Chen YK, Mendolia TF, et al.: Improved acid exposure and symptom scores 3 months post-Enteryx: initial US randomized, controlled trial results. Gastroenterology 2005, 129:371–372.

    Article  Google Scholar 

  14. Fockens P, Bruno MJ, Gabbrielli A, et al.: Endoscopic augmentation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease: a multicenter study of the Gatekeeper Reflux Repair System. Endoscopy 2004, 36:682–689.

    Article  PubMed  CAS  Google Scholar 

  15. Falk GW, Fennerty MB, Rothstein RI: AGA Institute technical review on the use of endoscopic therapy for gastroesophageal reflux disease. Gastroenterology 2006, 131:1315–1336.

    Article  PubMed  Google Scholar 

  16. Kahrilas PJ: Radiofrequency therapy of the lower esophageal sphincter for treatment of GERD. Gastrointest Endosc 2003, 57:723–731.

    Article  PubMed  Google Scholar 

  17. Triadafilopoulos G, DiBaise JK, Notrant TT, et al.: Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD. Gastrointest Endosc 2001, 53:407–415.

    Article  PubMed  CAS  Google Scholar 

  18. Triadafilopoulos G, Dibaise JK, Notrant TT, et al.: The Stretta procedure for the treatment of GERD: 6-and 12-month follow-up of the U.S. open label trial. Gastrointest Endosc 2002, 55:149–156.

    Article  PubMed  Google Scholar 

  19. Corley DA, Katz P, Wo J, et al.: Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial. Gastroenterology 2003, 125:668–676.

    Article  PubMed  Google Scholar 

  20. Haider M, Iqbal A, Filipi CJ: Endoluminal gastroplasty: a new treatment for gastroesophageal reflux disease. Thorac Surg Clin 2005, 15:385–394.

    Article  PubMed  Google Scholar 

  21. Filipi CJ, Lehman GA, Rothstein RI, et al.: Trans-oral, flexible endoscopic suturing for treatment of GERD: a multi-center trial. Gastrointest Endosc 2001, 53:416–422.

    Article  PubMed  CAS  Google Scholar 

  22. Chen YK, Raijman I, Ben-Menachem T, et al.: Long-term outcomes of endoluminal gastroplication: a U.S. multicenter trial. Gastrointest Endosc 2005, 61:659–667.

    Article  PubMed  Google Scholar 

  23. Rothstein RI, Hynes ML, Grove MR, et al.: Endoscopic gastric plication (EndoCinch) for GERD: a randomized, sham-controlled, blinded, single-center study [abstract]. Gastrointest Endosc 2004, 59:AB111.

    Google Scholar 

  24. Park P, Hall-Angeras M, Ohlin B, et al.: A prospective, multicenter, randomized, single-blind, parallel group study on the comparison between endoscopic cardia suturing and sham operation as a treatment of patients with gastroesophageal reflux symptoms [abstract]. Gastroenterology 2005, 128(Suppl 2):A–95.

    Google Scholar 

  25. Schwartz MP, Wellink H, Gooszen HG, et al.: A blinded, randomized, sham-controlled trial of endoscopic gastroplication for the treatment of gastro-esophageal reflux disease (GERD): preliminary results [abstract]. Gastrointest Endosc 2005, 61:AB95.

    Article  Google Scholar 

  26. Liu JJ, Carr-Locke DL, Lee LS, et al.: Endoluminal gastroplication for treatment of patients with classic gastroesophageal reflux symptoms and 24-h pH studies. Scand J Gastroenterol 2004, 39:615–620.

    Article  PubMed  CAS  Google Scholar 

  27. Velanovich V, Ben-Menachem T, Goel S: Case-control comparison of endoscopic gastroplication with laparoscopic fundoplication in the management of gastroesophageal reflux disease: early symptomatic outcomes. Surg Laparosc Endosc Percutan Tech 2002, 12:219–223.

    Article  PubMed  Google Scholar 

  28. Chadalavada R, Line E, Swafford V, et al.: Comparative results of endoluminal gastroplasty and laparoscopic anti-reflux surgery for the treatment of GERD. Surg Endosc 2004, 18:261–265.

    Article  PubMed  CAS  Google Scholar 

  29. Schiefke I, Neumann S, Zabel-Langhennig A, et al.: Use of an endoscopic suturing device (the “ESD”) to treat patients with gastroesophageal reflux disease, after unsuccessful EndoCinch endoluminal gastroplication: another failure. Endoscopy 2005, 37:700–705.

    Article  PubMed  CAS  Google Scholar 

  30. Schilling D, Kiesslich R, Galle PR, et al.: Endoluminal therapy of GERD with a new endoscopic suturing device. Gastrointest Endosc 2005, 62:37–43.

    Article  PubMed  Google Scholar 

  31. Felsher J, Farres H, Chand B, et al.: Mucosal apposition in endoscopic suturing. Gastrointest Endosc 2003, 58:867–868.

    Article  PubMed  Google Scholar 

  32. Chuttani R: Endoscopic full-thickness plication: the device, technique, pre-clinical and early clinical experience. Gastrointest Endosc Clin North Am 2003, 13:109–116.

    Article  Google Scholar 

  33. Pleskow D, Rothstein R, Lo L, et al.: Endoscopic full-thickness plication for GERD: a multicenter study. Gastrointest Endosc 2004, 59:163–171.

    Article  PubMed  Google Scholar 

  34. Rothstein R, Filipi C, Caca K, et al.: Endoscopic full-thickness plication for the treatment of gastroesophageal reflux disease: a randomized, sham-controlled trial. Gastroenterology 2006, 131:704–712.

    Article  PubMed  Google Scholar 

  35. Sgouros SN, Bergele C: Endoscopic therapy for gastroesophageal reflux disease: a systematic review. Digestion 2006, 74:1–14.

    Article  PubMed  Google Scholar 

  36. Herron DM, Birkett DH, Thompson CC, et al.: Gastric bypass pouch and stoma reduction using a transoral endoscopic anchor placement system: a feasibility study. Surg Endosc 2007 Nov 20 (Epub ahead of print).

  37. Cadiere GB, Rajan A, Germay O, et al.: Endoluminal fundoplication by a transoral device for the treatment of GERD: a feasibility study. Surg Endosc 2008, 22:333–342.

    Article  PubMed  CAS  Google Scholar 

  38. Fritscher-Ravens A, Swain P: Endoluminal fundoplication—the Hill procedure. Minim Invasive Ther Allied Technol 2006, 15:366–372.

    Article  PubMed  Google Scholar 

  39. Fritscher-Ravens A, Mosse CA, Mukherjee D, et al.: Transgastric gastropexy and hiatal hernia repair for GERD under EUS control: a porcine model. Gastrointest Endosc 2004, 59:89–95.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher C. Thompson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ryou, M., Thompson, C.C. Endoscopic therapy for GERD: Does it have a future?. Curr Gastroenterol Rep 10, 215–221 (2008). https://doi.org/10.1007/s11894-008-0046-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-008-0046-3

Keywords

Navigation