Clin Endosc.  2023 Nov;56(6):681-692. 10.5946/ce.2023.182.

Role of endoscopy in gastroesophageal reflux disease

• Simadibrata DM
• Lesmana E
• Fass R

• KMID: 2547888
• DOI: http://doi.org/10.5946/ce.2023.182

Abstract

In general, gastroesophageal reflux disease (GERD) is diagnosed clinically based on typical symptoms and/or response to proton pump inhibitor treatment. Upper gastrointestinal endoscopy is reserved for patients presenting with alarm symptoms, such as dysphagia, odynophagia, significant weight loss, gastrointestinal bleeding, or anorexia; those who meet the criteria for Barrett’s esophagus screening; those who report a lack or partial response to proton pump inhibitor treatment; and those with prior endoscopic or surgical anti-reflux interventions. Newer endoscopic techniques are primarily used to increase diagnostic yield and provide an alternative to medical or surgical treatment for GERD. The available endoscopic modalities for the diagnosis of GERD include conventional endoscopy with white-light imaging, high-resolution and high-magnification endoscopy, chromoendoscopy, image-enhanced endoscopy (narrow-band imaging, I- SCAN, flexible spectral imaging color enhancement, blue laser imaging, and linked color imaging), and confocal laser endomicroscopy. Endoscopic techniques for treating GERD include esophageal radiofrequency energy delivery/Stretta procedure, transoral incisionless fundoplication, and endoscopic full-thickness plication. Other novel techniques include anti-reflux mucosectomy, peroral endoscopic cardiac constriction, endoscopic submucosal dissection, and endoscopic band ligation. Currently, many of the new endoscopic techniques are not widely available, and their use is limited to centers of excellence.

Keyword

Diagnosis; Endoscopy; Gastroesophageal reflux disease; Treatment

Figure

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  Fig. 1. White-light endoscopic image of Los Angeles grade B erosive esophagitis.

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  Fig. 2. Narrow-band imaging of the esophagogastric junction of the same patient presented in Figure 1.

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  Fig. 3. (A) The Stretta device with a four-needle balloon catheter system. (B) Stretta procedure. (C) The sites of radiofrequency energy delivery. (D) Post-procedure effect at the esophagogastric junction level. Adapted from Shibli and Fass. Curr Treat Options Gastro 2021;19:399–420, with permission.40

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  Fig. 4. (A) The transoral incisionless fundoplication (TIF) device. (B–E) The different steps of the TIF procedure. Adapted from Shibli and Fass. Curr Treat Options Gastro 2021;19:399–420, with permission.40

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  Fig. 5. (A) Full-thickness endoscopic plication device (GERD-X). (B–E) GERD-X inside the stomach in retroflexed view. The different steps of the GERD-X procedure. GERD, gastroesophageal reflux disease. Adapted from Shibli and Fass. Curr Treat Options Gastro 2021;19:399–420, with permission.40

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  Fig. 6. (A) The Medigus ultrasonic surgical endostapler (MUSE) device. (B–D) The different steps of the MUSE procedure. Adapted from Shibli and Fass. Curr Treat Options Gastro 2021;19:399–420, with permission.40

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