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Digestive Disease Interventions 2021; 05(02): 199-206
DOI: 10.1055/s-0041-1729946
Special Communication

Endoscopic Management of Gastroesophageal Reflux Disease

Colin G. DeLong
1   Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
,
Joshua S. Winder
2   Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Abstract

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.

Keywords

refractory GERD - endoscopy - TIF - Stretta - ARMS

Disclosures

None.




Publication History

Received: 25 September 2020

Accepted: 01 April 2021

Article published online:
25 May 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Patti MG. An evidence-based approach to the treatment of gastroesophageal reflux disease. JAMA Surg 2016; 151 (01) 73-78
    CrossrefPubMedGoogle Scholar
  • 2 Spechler SJ, Souza RF. Barrett's esophagus. N Engl J Med 2014; 371 (09) 836-845
    CrossrefPubMedGoogle Scholar
  • 3 Triadafilopoulos G, Clarke JO, Hawn M. Precision GERD management for the 21st century. Dis Esophagus 2017; 30 (09) 1-6
    CrossrefPubMedGoogle Scholar
  • 4 Mermelstein J, Chait Mermelstein A, Chait MM. Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions. Clin Exp Gastroenterol 2018; 11: 119-134
    CrossrefPubMedGoogle Scholar
  • 5 Sandhu DS, Fass R. Current trends in the management of gastroesophageal reflux disease. Gut Liver 2018; 12 (01) 7-16
    CrossrefPubMedGoogle Scholar
  • 6 Bazerbachi F, Krishnan K, Abu Dayyeh BK. Endoscopic GERD therapy: a primer for the transoral incisionless fundoplication procedure. Gastrointest Endosc 2019; 90 (03) 370-383
    CrossrefPubMedGoogle Scholar
  • 7 Jobe BA, O'Rourke RW, McMahon BP. et al. Transoral endoscopic fundoplication in the treatment of gastroesophageal reflux disease: the anatomic and physiologic basis for reconstruction of the esophagogastric junction using a novel device. Ann Surg 2008; 248 (01) 69-76
    CrossrefPubMedGoogle Scholar
  • 8 Chang KJ, Bell R. Transoral incisionless fundoplication. Gastrointest Endosc Clin N Am 2020; 30 (02) 267-289
    CrossrefPubMedGoogle Scholar
  • 9 Testoni PA, Corsetti M, Di Pietro S. et al. Effect of transoral incisionless fundoplication on symptoms, PPI use, and pH-impedance refluxes of GERD patients. World J Surg 2010; 34 (04) 750-757
    CrossrefPubMedGoogle Scholar
  • 10 Cadière GB, Buset M, Muls V. et al. Antireflux transoral incisionless fundoplication using EsophyX: 12-month results of a prospective multicenter study. World J Surg 2008; 32 (08) 1676-1688
    CrossrefPubMedGoogle Scholar
  • 11 Rinsma NF, Smeets FG, Bruls DW. et al. Effect of transoral incisionless fundoplication on reflux mechanisms. Surg Endosc 2014; 28 (03) 941-949
    CrossrefPubMedGoogle Scholar
  • 12 Trad KS, Barnes WE, Simoni G. et al. Transoral incisionless fundoplication effective in eliminating GERD symptoms in partial responders to proton pump inhibitor therapy at 6 months: the TEMPO Randomized Clinical Trial. Surg Innov 2015; 22 (01) 26-40
    CrossrefPubMedGoogle Scholar
  • 13 Trad KS, Barnes WE, Prevou ER. et al. The TEMPO trial at 5 years: transoral fundoplication (TIF 2.0) is safe, durable, and cost-effective. Surg Innov 2018; 25 (02) 149-157
    CrossrefPubMedGoogle Scholar
  • 14 Håkansson B, Montgomery M, Cadiere GB. et al. Randomised clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD. Aliment Pharmacol Ther 2015; 42 (11-12): 1261-1270
    CrossrefPubMedGoogle Scholar
  • 15 Witteman BPL, Conchillo JM, Rinsma NF. et al. Randomized controlled trial of transoral incisionless fundoplication vs. proton pump inhibitors for treatment of gastroesophageal reflux disease. Am J Gastroenterol 2015; 110 (04) 531-542
    CrossrefPubMedGoogle Scholar
  • 16 Bell RCW, Mavrelis PG, Barnes WE. et al. A prospective multicenter registry of patients with chronic gastroesophageal reflux disease receiving transoral incisionless fundoplication. J Am Coll Surg 2012; 215 (06) 794-809
    CrossrefPubMedGoogle Scholar
  • 17 Bell RCW, Barnes WE, Carter BJ. et al. Transoral incisionless fundoplication: 2-year results from the prospective multicenter U.S. study. Am Surg 2014; 80 (11) 1093-1105
    CrossrefPubMedGoogle Scholar
  • 18 Richter JE, Kumar A, Lipka S, Miladinovic B, Velanovich V. Efficacy of laparoscopic Nissen fundoplication vs transoral incisionless fundoplication or proton pump inhibitors in patients with gastroesophageal reflux disease: a systematic review and network meta-analysis. Gastroenterology 2018; 154 (05) 1298-1308.e7
    CrossrefPubMedGoogle Scholar
  • 19 Huang X, Chen S, Zhao H. et al. Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc 2017; 31 (03) 1032-1044
    CrossrefPubMedGoogle Scholar
  • 20 McCarty TR, Itidiare M, Njei B, Rustagi T. Efficacy of transoral incisionless fundoplication for refractory gastroesophageal reflux disease: a systematic review and meta-analysis. Endoscopy 2018; 50 (07) 708-725
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Edriss H, El-Bakush A, Nugent K. Esophageal perforation and bilateral empyema following endoscopic EsophyX transoral incisionless fundoplication. Clin Endosc 2014; 47 (06) 560-563
    CrossrefPubMedGoogle Scholar
  • 22 Titus JM, Mason DP, Raymond DP, Rice TW, Murthy SC. Esophagopulmonary fistula and left lung abscess after transoral incisionless fundoplication. Ann Thorac Surg 2013; 96 (02) 689-691
    CrossrefPubMedGoogle Scholar
  • 23 Hoppo T, Immanuel A, Schuchert M. et al. Transoral incisionless fundoplication 2.0 procedure using EsophyX™ for gastroesophageal reflux disease. J Gastrointest Surg 2010; 14 (12) 1895-1901
    CrossrefPubMedGoogle Scholar
  • 24 Chimukangara M, Jalilvand AD, Melvin WS, Perry KA. Long-term reported outcomes of transoral incisionless fundoplication: an 8-year cohort study. Surg Endosc 2019; 33 (04) 1304-1309
    CrossrefPubMedGoogle Scholar
  • 25 Puri R, Smith CD, Bowers SP. The spectrum of surgical remediation of transoral incisionless fundoplication-related failures. J Laparoendosc Adv Surg Tech A 2018; 28 (09) 1089-1093
    CrossrefPubMedGoogle Scholar
  • 26 Perry KA, Linn JG, Eakin JL, Onders RP, Velanovich V, Melvin WS. Transoral incisionless fundoplication does not significantly increase morbidity of subsequent laparoscopic Nissen fundoplication. J Laparoendosc Adv Surg Tech A 2013; 23 (05) 456-458
    CrossrefPubMedGoogle Scholar
  • 27 Ashfaq A, Rhee HK, Harold KL. Revision of failed transoral incisionless fundoplication by subsequent laparoscopic Nissen fundoplication. World J Gastroenterol 2014; 20 (45) 17115-17119
    CrossrefPubMedGoogle Scholar
  • 28 Witteman BPL, Kessing BF, Snijders G, Koek GH, Conchillo JM, Bouvy ND. Revisional laparoscopic antireflux surgery after unsuccessful endoscopic fundoplication. Surg Endosc 2013; 27 (06) 2231-2236
    CrossrefPubMedGoogle Scholar
  • 29 Bell RCW, Kurian AA, Freeman KD. Laparoscopic anti-reflux revision surgery after transoral incisionless fundoplication is safe and effective. Surg Endosc 2015; 29 (07) 1746-1752
    CrossrefPubMedGoogle Scholar
  • 30 Fanous M, Jaehne A, Simbob J. The benefits of nonablative radiofrequency treatment of the lower esophageal sphincter after transoral incisionless fundoplication. Am Surg 2020; 86 (11) 1525-1527
    CrossrefPubMedGoogle Scholar
  • 31 Nicolau AE, Lobonţiu A. Transoral incisionless fundoplication TIF 2.0 with “Esophyx Z®” device for GERD: seven years after endo lumenal fundoplication. World's first case report. Chirurgia (Bucur) 2018; 113 (06) 849-856
    CrossrefPubMedGoogle Scholar
  • 32 Testoni PA, Vailati C, Testoni S, Corsetti M. Transoral incisionless fundoplication (TIF 2.0) with EsophyX for gastroesophageal reflux disease: long-term results and findings affecting outcome. Surg Endosc 2012; 26 (05) 1425-1435
    CrossrefPubMedGoogle Scholar
  • 33 Testoni PA, Testoni S, Mazzoleni G, Vailati C, Passaretti S. Long-term efficacy of transoral incisionless fundoplication with Esophyx (TIF 2.0) and factors affecting outcomes in GERD patients followed for up to 6 years: a prospective single-center study. Surg Endosc 2015; 29 (09) 2770-2780
    CrossrefPubMedGoogle Scholar
  • 34 Rabach L, Saad AR, Velanovich V. How to choose among fundoplication, magnetic sphincter augmentation or transoral incisionless fundoplication. Curr Opin Gastroenterol 2019; 35 (04) 371-378
    CrossrefPubMedGoogle Scholar
  • 35 Testoni PA, Mazzoleni G, Testoni SGG. Transoral incisionless fundoplication for gastro-esophageal reflux disease: techniques and outcomes. World J Gastrointest Pharmacol Ther 2016; 7 (02) 179-189
    CrossrefPubMedGoogle Scholar
  • 36 Chen S, Jarboe MD, Teitelbaum DH. Effectiveness of a transluminal endoscopic fundoplication for the treatment of pediatric gastroesophageal reflux disease. Pediatr Surg Int 2012; 28 (03) 229-234
    CrossrefPubMedGoogle Scholar
  • 37 Robertson JO, Jarboe MD. Long-term outcomes of transoral incisionless fundoplication in a high-risk pediatric population. J Laparoendosc Adv Surg Tech A 2018; 28 (01) 95-100
    CrossrefPubMedGoogle Scholar
  • 38 Ihde II GM, Pena C, Scitern C, Brewer S. pH scores in hiatal repair with transoral incisionless fundoplication. JSLS 2019; 23 (01) e2018.00087
    CrossrefPubMedGoogle Scholar
  • 39 Janu P, Shughoury AB, Venkat K. et al. Laparoscopic hiatal hernia repair followed by transoral incisionless fundoplication with EsophyX device (HH + TIF): efficacy and safety in two community hospitals. Surg Innov 2019; 26 (06) 675-686
    CrossrefPubMedGoogle Scholar
  • 40 Fanous MY. Benefit of laparoendoscopic repair of hiatal hernia in the presence of aberrant left hepatic artery. JSLS 2019; 23 (01) e2019.00004
    CrossrefPubMedGoogle Scholar
  • 41 Triadafilopoulos G. Stretta: a valuable endoscopic treatment modality for gastroesophageal reflux disease. World J Gastroenterol 2014; 20 (24) 7730-7738
    CrossrefPubMedGoogle Scholar
  • 42 Utley DS. The Stretta procedure: device, technique, and pre-clinical study data. Gastrointest Endosc Clin N Am 2003; 13 (01) 135-145
    CrossrefPubMedGoogle Scholar
  • 43 Franciosa M, Triadafilopoulos G, Mashimo H. Stretta radiofrequency treatment for GERD: a safe and effective modality. Gastroenterol Res Pract 2013; 2013: 783815
    CrossrefPubMedGoogle Scholar
  • 44 Arts J, Bisschops R, Blondeau K. et al. A double-blind sham-controlled study of the effect of radiofrequency energy on symptoms and distensibility of the gastro-esophageal junction in GERD. Am J Gastroenterol 2012; 107 (02) 222-230
    CrossrefPubMedGoogle Scholar
  • 45 Arts J, Sifrim D, Rutgeerts P, Lerut A, Janssens J, Tack J. Influence of radiofrequency energy delivery at the gastroesophageal junction (the Stretta procedure) on symptoms, acid exposure, and esophageal sensitivity to acid perfusion in gastroesophageal reflux disease. Dig Dis Sci 2007; 52 (09) 2170-2177
    CrossrefPubMedGoogle Scholar
  • 46 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 (05) 337-342
    CrossrefPubMedGoogle Scholar
  • 47 He S, Xu F, Xiong X. et al. Stretta procedure versus proton pump inhibitors for the treatment of nonerosive reflux disease: A 6-month follow-up. Med (United States) 2020; 99 (03) DOI: 10.1097/MD.0000000000018610.
    CrossrefPubMedGoogle Scholar
  • 48 Aziz AM, El-Khayat HR, Sadek A. et al. A prospective randomized trial of sham, single-dose Stretta, and double-dose Stretta for the treatment of gastroesophageal reflux disease. Surg Endosc 2010; 24 (04) 818-825
    CrossrefPubMedGoogle Scholar
  • 49 Triadafilopoulos G, DiBaise JK, Nostrant 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 (02) 149-156
    CrossrefPubMedGoogle Scholar
  • 50 Wolfsen HC, Richards WO. The Stretta procedure for the treatment of GERD: a registry of 558 patients. J Laparoendosc Adv Surg Tech A 2002; 12 (06) 395-402
    CrossrefPubMedGoogle Scholar
  • 51 Fass R, Cahn F, Scotti DJ, Gregory DA. Systematic review and meta-analysis of controlled and prospective cohort efficacy studies of endoscopic radiofrequency for treatment of gastroesophageal reflux disease. Surg Endosc 2017; 31 (12) 4865-4882
    CrossrefPubMedGoogle Scholar
  • 52 Torquati A, Houston HL, Kaiser J, Holzman MD, Richards WO. Long-term follow-up study of the Stretta procedure for the treatment of gastroesophageal reflux disease. Surg Endosc 2004; 18 (10) 1475-1479
    CrossrefPubMedGoogle Scholar
  • 53 Noar MD, Lotfi-Emran S. Sustained improvement in symptoms of GERD and antisecretory drug use: 4-year follow-up of the Stretta procedure. Gastrointest Endosc 2007; 65 (03) 367-372
    CrossrefPubMedGoogle Scholar
  • 54 Dughera L, Rotondano G, De Cento M, Cassolino P, Cisarò F. Durability of Stretta Radiofrequency Treatment for GERD. Durability of Stretta radiofrequency treatment for GERD: results of an 8-year follow-up. Gastroenterol Res Pract 2014; 2014: 531907
    CrossrefPubMedGoogle Scholar
  • 55 Yan C, Liang WT, Wang ZG. et al. Comparison of Stretta procedure and toupet fundoplication for gastroesophageal reflux disease-related extra-esophageal symptoms. World J Gastroenterol 2015; 21 (45) 12882-12887
    CrossrefPubMedGoogle Scholar
  • 56 Liang WT, Yan C, Wang ZG. et al. Early and midterm outcome after laparoscopic fundoplication and a minimally invasive endoscopic procedure in patients with gastroesophageal reflux disease: a prospective observational study. J Laparoendosc Adv Surg Tech A 2015; 25 (08) 657-661
    CrossrefPubMedGoogle Scholar
  • 57 Liang W, Wu J, Hu Z, Wang Z, Zhu G, Zhang C. Laparoscopic Nissen fundoplication is more effective in treating patients with GERD-related chronic cough than Stretta radiofrequency. Minerva Chir 2014; 69 (03) 121-127
    PubMedGoogle Scholar
  • 58 Liang WT, Wu JN, Wang F. et al. Five-year follow-up of a prospective study comparing laparoscopic Nissen fundoplication with Stretta radiofrequency for gastroesophageal reflux disease. Minerva Chir 2014; 69 (04) 217-223
    PubMedGoogle Scholar
  • 59 Comay D, Adam V, da Silveira EB, Kennedy W, Mayrand S, Barkun AN. The Stretta procedure versus proton pump inhibitors and laparoscopic Nissen fundoplication in the management of gastroesophageal reflux disease: a cost-effectiveness analysis. Can J Gastroenterol 2008; 22 (06) 552-558
    CrossrefPubMedGoogle Scholar
  • 60 Yeh RW, Triadafilopoulos G. Endoscopic antireflux therapy: the Stretta procedure. Thorac Surg Clin 2005; 15 (03) 395-403
    CrossrefPubMedGoogle Scholar
  • 61 Vogel SB, Rout WR, Martin TD. et al. Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg 2005; 241 (06) 1016-1023
    CrossrefPubMedGoogle Scholar
  • 62 Lutfi RE, Torquati A, Kaiser J, Holzman M, Richards WO. Three year's experience with the Stretta procedure: Did it really make a difference?. Surg Endosc 2005; 19 (02) 289-295
    CrossrefPubMedGoogle Scholar
  • 63 Toydemir T, Yerdel MA. Laparoscopic antireflux surgery after failed endoscopic treatments for gastroesophageal reflux disease. Surg Laparosc Endosc Percutan Tech 2011; 21 (01) 17-19
    CrossrefPubMedGoogle Scholar
  • 64 Auyang ED, Carter P, Rauth T, Fanelli RD. SAGES Guidelines Committee. SAGES clinical spotlight review: endoluminal treatments for gastroesophageal reflux disease (GERD). Surg Endosc 2013; 27 (08) 2658-2672
    CrossrefPubMedGoogle Scholar
  • 65 McClusky III DA, Khaitan L, Swafford VA, Smith CD. Radiofrequency energy delivery to the lower esophageal sphincter (Stretta procedure) in patients with recurrent reflux after antireflux surgery: can surgery be avoided?. Surg Endosc 2007; 21 (07) 1207-1211
    CrossrefPubMedGoogle Scholar
  • 66 Noar M, Squires P, Khan S. Radiofrequency energy delivery to the lower esophageal sphincter improves gastroesophageal reflux patient-reported outcomes in failed laparoscopic Nissen fundoplication cohort. Surg Endosc 2017; 31 (07) 2854-2862
    CrossrefPubMedGoogle Scholar
  • 67 Liu DC, Somme S, Mavrelis PG. et al. Stretta as the initial antireflux procedure in children. J Pediatr Surg 2005; 40 (01) 148-151 , discussion 151–152
    CrossrefPubMedGoogle Scholar
  • 68 Islam S, Geiger JD, Coran AG. et al. Use of radiofrequency ablation of the lower esophageal sphincter to treat recurrent gastroesophageal reflux disease. J Pediatr Surg 2004; 39 (03) 282-286
    CrossrefPubMedGoogle Scholar
  • 69 Mattar SG, Qureshi F, Taylor D, Schauer PR. Treatment of refractory gastroesophageal reflux disease with radiofrequency energy (Stretta) in patients after Roux-en-Y gastric bypass. Surg Endosc 2006; 20 (06) 850-854
    CrossrefPubMedGoogle Scholar
  • 70 Khidir N, Angrisani L, Al-Qahtani J, Abayazeed S, Bashah M. Initial experience of endoscopic radiofrequency waves delivery to the lower esophageal sphincter (Stretta procedure) on symptomatic gastroesophageal reflux disease post-sleeve gastrectomy. Obes Surg 2018; 28 (10) 3125-3130
    CrossrefPubMedGoogle Scholar
  • 71 Satodate H, Inoue H, Yoshida T. et al. Circumferential EMR of carcinoma arising in Barrett's esophagus: case report. Gastrointest Endosc 2003; 58 (02) 288-292
    CrossrefPubMedGoogle Scholar
  • 72 Inoue H, Ito H, Ikeda H. et al. Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: A pilot study. Ann Gastroenterol 2014; 27 (04) 346-351
    PubMedGoogle Scholar
  • 73 Sumi K, Inoue H, Kobayashi Y. et al. Endoscopic treatment of proton pump inhibitor-refractory gastroesophageal reflux disease with anti-reflux mucosectomy: experience of 109 cases. Dig Endosc 2021; 33 (03) 347-354
    CrossrefPubMedGoogle Scholar
  • 74 Yoo IK, Ko WJ, Kim HS. et al. Anti-reflux mucosectomy using a cap-assisted endoscopic mucosal resection method for refractory gastroesophageal disease: a prospective feasibility study. Surg Endosc 2020; 34 (03) 1124-1131
    CrossrefPubMedGoogle Scholar
  • 75 Hedberg HM, Kuchta K, Ujiki MB. First experience with banded anti-reflux mucosectomy (ARMS) for GERD: feasibility, safety, and technique (with video). J Gastrointest Surg 2019; 23 (06) 1274-1278
    CrossrefPubMedGoogle Scholar
  • 76 Patil G, Dalal A, Maydeo A. Feasibility and outcomes of anti-reflux mucosectomy for proton pump inhibitor dependent gastroesophageal reflux disease: first Indian study (with video). Dig Endosc 2020; 32 (05) 745-752
    CrossrefPubMedGoogle Scholar
  • 77 Funk LM, Zhang JY, Drosdeck JM, Melvin WS, Walker JP, Perry KA. Long-term cost-effectiveness of medical, endoscopic and surgical management of gastroesophageal reflux disease. Surgery 2015; 157 (01) 126-136
    CrossrefPubMedGoogle Scholar
  • 78 Harewood GC, Gostout CJ. Cost analysis of endoscopic antireflux procedures: endoluminal plication vs. radiofrequency coagulation vs. treatment with a proton pump inhibitor. Gastrointest Endosc 2003; 58 (04) 493-499
    PubMedGoogle Scholar
  • 79 Gawron AJ, Bell R, Abu Dayyeh BK. et al. Surgical and endoscopic management options for patients with GERD based on proton pump inhibitor symptom response: recommendations from an expert U.S. panel. Gastrointest Endosc 2020; 92 (01) 78-87.e2
    CrossrefPubMedGoogle Scholar