Clin Endosc.  2013 May;46(3):230-234. 10.5946/ce.2013.46.3.230.

Endoscopic Treatment of Refractory Gastroesohageal Reflux Disease

• Kim WH
• Park PW
• Hahm KB
• Hong SP

• KMID: 2048925
• DOI: http://doi.org/10.5946/ce.2013.46.3.230

Abstract

Though efficient acid suppression with proton pump inhibitors (PPIs) remains the mainstay of treatment of gastroesophageal reflux disease (GERD), some of the patients showed refractory response to PPIs, necessitating further intervention. After increasing dose of PPIs and other kinds of pharmacological intervention adopting prokinetics or others, variable endoscopic treatments are introduced for the treatment of these refractory cases. The detailed introduction regarding endoscopic treatment for GERD is forwarded in this review article. Implantation of reabsorbable or synthetic materials in the distal esophagus was tried in vain and is expelled from the market due to limited efficacy and serious complication. Radiofrequency energy delivery (Stretta) and transoral incisionless fundoplication (EsophyX) are actively tried currently.

Keyword

Gastroesophageal reflux; Endoscopic treatment; Stretta; EsophyX

MeSH Terms

Esophagus
Fundoplication
Gastroesophageal Reflux
Humans
Proton Pump Inhibitors
Proton Pump Inhibitors

Figure

• 

  Fig. 1 (A) The stretta system. The four electrodes provide 60 to 300 J of radiofrequency energy to each needle, heating the surrounding muscle tissue. (B) The lower esophageal sphincter is tightened after radiofrequency ablation.

• 

  Fig. 2 (A) Enterynx is injected into the muscular and submucosal layers at a point about 1 to 2 mm caudal to the Z-line. (B) The distensibility and shape of esophagogastric junction is changed.

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  Fig. 3 (A) Gastric mucosa of gastroesophageal junction is retracted and wrapped. Sutures are delivered across the tissue and full thickness plication is completed. (B) EnterynX creates a tight valve.

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