Therapeutic flexible endoscopy replacing surgery: Part 2—Gastroesophageal reflux disease and its complications

Gastroesophageal reflux disease (GERD) is a complex entity whereby gastric contents reflux into the esophagus owing to either a lack of a natural barrier between the stomach and esophagus or a dysfunction of foregut motility. In many cases, elements of both are present. GERD presents with either typical or atypical symptoms and can lead to metaplasia of the esophageal epithelium, a precancerous condition called Barrett's esophagus (BE). GERD is a chronic disease, and like other chronic diseases, it requires a thorough evaluation to deduce the exact etiology and also necessitates a dynamic and evolving spectrum of therapy. Until relatively recently, the spectrum of treatment for chronic GERD and BE included lifestyle modification, pharmacotherapy, and laparoscopic fundoplication. Considering the effect of chronic GERD on health and quality of life, and with further progress in understanding the disease process, newer and less invasive techniques for treatment have emerged and developed over the past decade. The 2 current FDA-approved therapies for the endolumenal treatment of GERD are transoral incisionless fundoplication with the Esophyx2 device and the Stretta system. If chronic GERD has lead to BE, endolumenal therapies include radiofrequency ablation with the HALO system or endoscopic resection of the metaplastic changes. Data regarding the outcomes of each of these procedures are accumulating rapidly; however, further data and evaluation are necessary to determine the most appropriate place for these procedures in the spectrum of therapy for chronic GERD and BE.