Endoscopic Management of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) occurs in up to 20% of the population. Effective management of the condition is essential to reduce both symptoms and the risk for dysplastic changes of esophageal mucosa. Although lifestyle and diet modification and proton-pump inhibitors (PPIs) remain the standard of therapy, approximately 30% of patients experience persistent or recurrent symptoms with this therapy, which has been labeled PPI-refractory GERD. Surgical antireflux procedures have long been the standard therapy for PPI-refractory GERD, but drawbacks include cost and surgical morbidity. Endoscopic techniques for GERD management have been developed over the past 20 years including transoral incisionless fundoplication, the Stretta procedure, and antireflux mucosectomy. This article will review the current literature on each of these endoscopic procedures as well as highlight areas where further research is needed to fully understand the best practices for use of these endoscopic techniques for the management of PPI-refractory GERD.