Endoscopic treatment of gastro-oesophageal reflux disease: the new kid on the block.
BACKGROUND
Gastro-oesophageal reflux disease is a common disease entity with approximately 7% of European adults experiencing significant daily symptoms. The impact of reflux disease on the quality of life is considerable. Complications of reflux disease include oesophagitis, stricture, Barrett's and pulmonary symptoms. Most patients can be adequately managed by treatment with a proton-pump inhibitor. However, symptom relapse is common after cessation of therapy, thus many patients are committed to life-long therapy. Until recently, anti-reflux surgery was the single therapeutic alternative. Now, novel endoscopic techniques have become available to treat patients suffering from reflux disease. Application of these techniques is challenging.


METHODS
Update on new endoscopic techniques for treatment of reflux discase.


RESULTS
Currently available endoscopic techniques include endoscopic suturing, radiofrequency ablation and biopolymer injection. Interventions typically take 30-40 min and can be performed under conscious sedation. First reports describe successful reduction of symptoms. Six months after therapy. reportedly 58%-85% of patients are off proton-pump inhibition. Yet, there are conflicting results on 24-h pH measurement and insufficient data on the mechanism of altered oesophageal motility. Long-term data are not yet available. In our series of over 50 procedures, no serious complications have occurred.


CONCLUSIONS
Endoscopic treatment of reflux disease is feasible and safe. Techniques reduce both symptoms and medication use associated with the disease, albeit with an uncertain long-term outcome. As pursuit of this technology is appealing, techniques are being introduced before thorough comparison and evaluation of therapeutic benefit have been completed. Comparative studies between conventional anti-reflux treatment and various luminal anti-reflux therapies are needed and long-term efficacy remains to be established.
Haringsma
J
J
Dept. of' Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. j.haringsma@ErasmusMC.nl
Siersema
P D
PD
Kuipers
E J
EJ
D000328:Adult; D001704:Biopolymers / Q000008:administration & dosage; D017115:Catheter Ablation / Q000379:methods; D016145:Endoscopy, Digestive System / Q000379:methods*; D004943:Esophagogastric Junction; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000628:therapy*; D006801:Humans; D007267:Injections; D013536:Suture Techniques
D001704:Biopolymers