Endoscopy 2005; 37(5): 470-478
DOI: 10.1055/s-2005-861194
Review
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Treatment of Gastroesophageal Reflux Disease

V.  Annese1 [*] , G.  Caletti2 [**] , L.  Cipolletta3 [**] , G.  Costamagna4 [**] , V.  D’Onofrio5 [*] , G.  Leandro6 [**] , M.  Koch7 [*] , F.  Pace8 [*] , R.  Penagini9 [*] , A.  Repici10 [**] , E.  Ricci11 [**] , S.  Vigneri12 [**] , G.  Zaninotto13 [*]
  • 1U.O. Gastroenterologia, Ospedale CSS-IRCCS, San Giovanni Rotondo, Italy
  • 2U.O. Gastroenterologia, Università di Bologna, Ospedale Castel S. Pietro Terme, Italy
  • 3U.O. Gastroenterologia, Ospedale Torre del Greco, Italy
  • 4U.O. Endoscopia Chirurgica, Policlinico “A. Gemelli”, Roma, Italy
  • 5U.O. Gastroenterologia, Ospedale “Moscati”, Avellino, Italy
  • 6U.O. Gastroenterologia, Ospedale IRCCS “De Bellis” Castellana Grotte, Italy
  • 7U. O. Gastroenterologia, Ospedale “S. Filippo Neri”, Roma, Italy
  • 8U.O. Gastroenterologia, Ospedale Universitario “L. Sacco”, Milano, Italy
  • 9U.O. e Cattedra di Gastroenterologia, Ospedale “Maggiore”, Milano, Italy
  • 10U.O. Gastroenterologia, Ospedale “Molinette”, Torino, Italy
  • 11U.O. Gastroenterologia, Ospedale Civile, Forlì, Italy
  • 12U.O. Gastroenterologia, Clinica Medica, Ospedale Civico Palermo, Italy
  • 13U.O. Chirurgia, Policlinico Universitario, Padova, Italy
Further Information

Publication History

Submitted 10 March 2004

Accepted after Revision 19 November 2004

Publication Date:
20 April 2005 (online)

Gastroesophageal reflux disease is a common chronic disorder which has a severe effect on the patient’s quality of life. In view of the high cost of medical therapy and the limitations of surgery, a variety of endoscopic techniques have been developed for the treatment of this condition, and these have shown apparently encouraging results, at least in the short term. However, promising results have been obtained in only around two-thirds of patients over a short-term follow-up period of about 6 months. Moreover, several inconsistencies have emerged between the efficacy of this form of treatment in improving symptoms and quality of life and a lack of improvement of objective parameters, such as lower esophageal sphincter pressure and esophageal acid exposure. The authors strongly endorse the need for comprehensive evaluation of clinical evidence on this topic. After an extensive evaluation of existing literature, we suggest that controlled studies are urgently needed in order to clarify the potential of endoscopic therapy, either in terms of cost-effectiveness or in comparison with standard therapy. Meanwhile, with regard to current practice, the use of endoscopic treatment should be limited to clinical trials, which should incorporate the provision of comprehensive and unbiased information to study patients.

References

  • 1 Holloway R H. The anti-reflux barrier and mechanisms of gastro-oesohageal reflux.  Baillieres Best Pract Res Clin Gastroenterol. 2000;  14 681-699
  • 2 Mittal R K, Holloway R H, Penagini R. et al . Transient lower esophageal sphincter relaxation.  Gastroenterology. 1995;  109 601-610
  • 3 Hirsch D P, Tytgat G NJ, Boechxstaens G EE. Transient lower esophageal sphincter relaxations: a pharmacological target for gastro-oesophageal reflux disease?.  [Review article] Aliment Pharmacol Ther. 2002;  16 17-26
  • 4 van Herwaarden M A, Samsom M, Smout A J. Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations.  Gastroenterology. 2000;  119 1439-1446
  • 5 Pandolfino J E, Shi G, Curry J. et al . Esophagogastric junction distensibility: a factor contributing to sphincter incompetence.  Am J Physiol Gastrointest Liver Physiol. 2002;  282 G1052-G1058
  • 6 Ramakrishnan A, Katz P O. Overview of medical therapy for gastroesophageal disease.  Gastrointest Endosc Clin N Am. 2003;  13 57-68
  • 7 Vigneri S, Termini R, Leandro G. et al . A comparison of five maintenance therapies for reflux esophagitis.  N Engl J Med. 1995;  333 1106-1110
  • 8 Moss S F, Armstrong D, Arnold R. et al . GERD 2003: a consensus on the way ahead.  Digestion. 2003;  67 111-117
  • 9 Harewood G C, Gostout C J. Cost analysis of endoscopic antireflux procedures: endoluminal plication vs. radiofrequency coagulation vs. treatment with a proton pump inhibitor.  Gastrointest Endosc. 2003;  58 493-499
  • 10 Low D E. Surgery for hiatal hernia and GERD: time for reappraisal and a balanced approach?.  Surg Endosc. 2001;  15 913-917
  • 11 Richter J E. Importance of bile reflux in Barrett’s esophagus.  Dig Dis. 2000 - 2001;  18 208-216
  • 12 Lundell L, Miettinen P, Myrvold H E. et al . Continued (5-year) follow-up of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease.  J Am Coll Surg. 2001;  192 172-179
  • 13 Kahrilas P J. Management of GERD: medical versus surgical.  Semin Gastrointest Dis. 2001;  12 3-15
  • 14 Klinkenberg-Knol E C, Festen H P, Jansen J B. et al . Long-term treatment with omeprazole for refractory reflux esophagitis: efficacy and safety.  Ann Intern Med. 1994;  121 161-167
  • 15 Vakil N, Shaw M, Kirby R. Clinical effectiveness of laparoscopic fundoplication in a US community.  Am J Med. 2003;  114 1-5
  • 16 Spechler S J, Lee E, Ahnen D. et al . Long-term outcome of medical and surgical therapies for gastroesophageal reflux diseases: follow-up of a randomized controlled trial.  JAMA. 2001;  285 2331-2338
  • 17 Lafullarde T, Watson D I, Jamieson G G. et al . Laparoscopic Nissen fundoplication: five-year results and beyond.  Arch Surg. 2001;  136 180-184
  • 18 Hinder R A, Filipi C J, Wetscher G. et al . Laparoscopic fundoplication is an effective treatment for gastroesophageal reflux disease.  Ann Surg. 1994;  220 472-481
  • 19 Klaus A, Hinder R A, DeVault K R. et al . Bowel dysfunction after laparoscopic antireflux surgery: incidence, severity, and clinical course.  Am J Med. 2003;  114 6-9
  • 20 Richter J E. Let the patient beware: the evolving truth about laparoscopic antireflux surgery.  Am J Med. 2003;  114 71-73
  • 21 Zaninotto G, Molena D, Ancona E. and the Study Group for the Laparoscopic Treatment of Gastroesophageal Reflux Disease of the Italian Society of Endoscopic Surgery . A prospective, multicenter study on laparoscopic treatment of gastroesophageal reflux in Italy: type of surgery, conversions, complications and early results.  Surg Endosc. 2000;  14 282-288
  • 22 Park P, Kjellin T, Swain P. Results of endoscopic gastroplasty for gastro-esophageal reflux disease [abstract].  Gastroenterology. 2001;  120 A3427
  • 23 Patel V. Clinical utility of ELGP for GERD disease in private practice [abstract].  Am J Gastroenterol. 2001;  9 A89
  • 24 Rothstein R. Endoscopic gastroplication for the treatment of GERD: two-year follow-up results [abstract].  Am J Gastroenterol. 2001;  9 A107
  • 25 Liu J, Knapp R, Silk J, Carr-Locke D L. Treatment of medication-refractory gastroesophageal reflux disease with endoluminal gastroplication [abstract].  Gastroenterology. 2002;  122 A1583
  • 26 Chen Y K, Raijman I, Ben-Menachem T. et al . Long-term experience with endoluminal gastroplication (ELGP): clinical and economic outcomes of the US multicenter trial [abstract].  Gastroenterology. 2002;  122 A690
  • 27 Abou-Rebyeh H, Hoepffner N, Osmanoglou N. et al . Endoscopic suturing is able to reduce pathological acid reflux in gastro-esophageal reflux disease [abstract].  Gastroenterology. 2002;  122 A1588
  • 28 Caca K, Schiefke I, Söder H. et al . Endoluminal gastroplication for gastro-esophageal reflux disease [abstract].  Gastroenterology. 2002;  122 A1888
  • 29 Arts J, Slootmaekers S, Sifrim D. et al . Endoluminal gastroplication (EndoCinch) in GERD patients refractory to PPI therapy [abstract].  Gastroenterology. 2002;  122 A391
  • 30 Costamagna G, Repici A, Tringali L. et al . Endoluminal gastroplication (ELGP) with the EndoCinch system: a retrospective analysis of the Italian multicenter experience [abstract].  Dig Liver Dis. 2003;  35 Suppl 4 S40
  • 31 Occhipinti P, Saettone M, Ballarè P. et al . Endoscopic suturing service (EndoCinch) for treatment of GERD: 1-year follow-up results [abstract].  Dig Liver Dis. 2003;  35 Suppl 4 S53
  • 32 Ben-Menachem T, Chen Y K, Raijman I. et al . Symptom recurrence after endoluminal gastroplication (ELGP) for GERD: comparison of initial versus repeat ELGP [abstract].  Gastroenterology. 2003;  124 A1737
  • 33 Mahmood Z, McMahon B P, Murphy E. et al . Quality of life after transesophageal endoscopic plication (EndoCinch) procedure for gastroesophageal reflux disease (GERD): a 1-year prospective study [abstract].  Gastroenterology. 2003;  124 A1509
  • 34 Thomson M, Afsal N, Fritscher-Ravens A. et al . Endoscopic gastroplication for the treatment of pediatric gastro-esophageal reflux disease [abstract].  Gastroenterology. 2003;  124 A563
  • 35 Liu J J, Schamberg N J, Saltzman J R, Carr-Locke J C. Endoscopic findings post-endoluminal gastroplication (ELGP) [abstract].  Gastroenterology. 2003;  124 A1742
  • 36 Lee L S, Liu J J, Carr-Locke D L, Saltzman J R. Does the number of sutures affect clinical outcome in endoluminal gastroplication?.  [Abstract] Gastroenterology. 2003;  124 A1739
  • 37 Zhang X, Tack J, Janssens J, Sifrim D. Acid and non-acid gastroesophageal reflux after endoscopic gastroplication. Evaluation of the antireflux barrier function with 24-hr pH-impedance [abstract].  Gastroenterology. 2003;  124 A748
  • 38 Lee L S, Liu J J, Carr-Locke D L, Saltzman J R. Effect of endoluminal gastroplication in patients with classic reflux symptoms and minimally abnormal esophageal pH studies [abstract].  Gastroenterology. 2003;  124 A686
  • 39 Ben-Menachem T, Goel S, Zonca M. et al . Endoscopic surveillance of plications after endoluminal gastroplication (ELGP) for GERD [abstract].  Gastroenterology. 2003;  124 A1731
  • 40 Chen Y K, Raijman I, Ben-Menachem T. et al . One-year follow up of endoluminal gastroplication (ELGP): clinical and economic outcomes of the US multicenter trial [abstract].  Gastroenterology. 2003;  124 A1887
  • 41 Pleskow D, Rothstein R, Kozarek R. et al . Endoscopic full-thickness plication for GERD: a multi-center study [abstract].  Gastroenterology. 2003;  124 A671
  • 42 Langhennig-Zabel A, Schiefke I, Neumann S. et al . Endoscopic gastroplication (EndoCinch) as an alternative option in treatment of GERD: an 18-month follow-up [abstract].  Gastroenterology. 2004;  126 A466
  • 43 Ponchon T, Boyer J, Grimaud J C. et al . A prospective multicenter phase II study to evaluate the EndoCinch suturing system for the treatment of GERD [abstract].  Gastroenterology. 2004;  126 A922
  • 44 Liu J J, Ookubo R, Saltzman J R. The clinical efficacy of the endoscopic suturing device for treatment of gastroesophageal reflux [abstract].  Gastroenterology. 2004;  126 A924
  • 45 Schilling D, Kiesslich R, Galle P R, Riemann J F. First experience with a new endoscopic suture device (ESD) for endoscopic endoluminal therapy for GERD [abstract].  Gastroenterology. 2004;  126 A924
  • 46 Filipi C J, Lehman G A, Rothstein R I. et al . Transoral, flexible endoscopic suturing for treatment of GERD: a multicenter trial.  Gastrointest Endosc. 2001;  53 416-422
  • 47 Mahmood Z, McMahon B P, Arfin Q. et al . EndoCinch therapy for gastro-oesophageal reflux disease: a 1-year prospective follow up.  Gut. 2003;  52 34-39
  • 48 Chuttani R, Sud R, Sachdev G. et al . A novel endoscopic full-thickness plicator for the treatment of GERD: a pilot study.  Gastrointest Endosc. 2003;  58 770-776
  • 49 Pleskow D, Rothstein R, Lo S. et al . Endoscopic full-thickness plication for the treatment of GERD: a multicenter trial.  Gastrointest Endosc. 2004;  59 163-171
  • 50 Velanovich V, Ben-Menachem T. Laparoscopic Nissen fundoplicaton after failed endoscopic gastroplication.  Laparoendosc Adv Surg Tech A. 2002;  12 305-308
  • 51 Tam W CE, Schoeman M N, Zhang Q. et al . Delivery of radiofrequency (RF) energy to the lower esophageal sphincter (LES) and gastric cardia inhibits transient LES relaxations and gastroesophageal reflux in patients with reflux disease.  Gut. 2003;  52 479-485
  • 52 Noar M, Knight S, Bidlack D. Impaired gastric emptyng in GERD patients improved after radiofrequency (RF) energy delivery to the gastroesophageal junction (Stretta procedure) [abstract].  Gastroenterology. 2002;  122 A558
  • 53 Triadafilopoulos G, DiBaise J K, Nostrant T. et al . Long-term experience with the Stretta procedure for the treatment of GERD: 6- and 12-month follow-up of the US open label trial [abstract].  Gastroenterology. 2001;  120 A577
  • 54 Mansell D E. Extended follow-up in patients treated with the Stretta procedure: a report on 29 patients [abstract].  Gastroenterology. 2002;  122 A1889
  • 55 Mavrelis P, Mirro J, Hurwich D. et al . Use of the Stretta procedure for the treatment of GERD: a community hospital experience [abstract].  Gastroenterology. 2002;  122 A1598
  • 56 Noar M, Lotfi S. Radio frequency (RF) energy ablation of the cardia and esophagogastric junction corrects GERD-associated gastroparesis [abstract].  Gastroenterology. 2002;  124 A675
  • 57 Noar M D, Knight S, Bidlack D. Long-term experience with the Stretta procedure in medically refractory GERD patients: the first 14 months [abstract].  Gastroenterology. 2003;  124 A1577
  • 58 Arts J, Van Olmen A, D’Haens G. et al . Radiofrequency delivery at the gastroesophageal junction in GERD improves acid exposure and symptoms and decreases esophageal sensitivity to acid infusion [abstract].  Gastroenterology. 2003;  124 A148
  • 59 Noar M, Lotfi S. Long-term experience with the Stretta procedure in the medication-refractory GERD patient [abstract].  Gastroenterology. 2003;  124 A673
  • 60 Meier P N, Nietzschmann T, Akin I. et al . Improvements in objective GERD parameters after radiofrequency energy delivery (Stretta procedure) [abstract].  Gastroenterology. 2003;  124 A2116
  • 61 Noar M, Xu L, Koch K L. Effect of radiofrequency ablation on gastric dysrhythmias and gastric emptying in patients with gastroesophageal reflux disease (GERD) and functional dyspepsia [abstract].  Gastroenterology. 2003;  124 A750
  • 62 Triadafilopoulos G. Clinical response after Stretta procedure for GERD reflects improvement in esophageal acid exposure [abstract].  Gastroenterology. 2003;  124 A749
  • 63 Noar M, Smith J. The Stretta procedure improves symptoms and anti-secretory drug use at 2 years, while normalizing gastric emptying function in the majority of impaired subjects [abstract].  Gastroenterology. 2004;  126 A922
  • 64 Triadafilopoulos G, DiBaise J K, Nostrant T T. et al . Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD.  Gastrointest Endosc. 2001;  53 407-415
  • 65 Wolfsen H C, Richards W O. The Stretta procedure for the treatment of GERD: a registry of 558 patients.  J Laparoendosc Adv Surg Tech A. 2002;  12 395-402
  • 66 Houston H, Khaitan L, Holzman M, Richards W O. First-year experience of patients undergoing the Stretta procedure.  Surg Endosc. 2003;  17 401-404
  • 67 DiBaise J K, Brand R E, Quigley E M. Endoluminal delivery of radiofrequency energy to the gastroesophageal junction in uncomplicated GERD: efficacy and potential mechanism of action.  Am J Gastroenterol. 2002;  97 833-842
  • 68 Triadafilopoulos G, DiBaise J K, Nostrant T T. et al . The Stretta procedure for the treatment of GERD: 6- and 12-month follow-up of the US open label trial.  Gastrointest Endosc. 2002;  55 149-156
  • 69 Richards W O, Scholz S, Khaitan L. et al . Initial experience with the Stretta procedure for the treatment of gastroesophageal reflux disease.  J Laparoendosc Adv Surg Tech A. 2001;  11 267-273
  • 70 Corley D A, Katz P, Wo J M. et al . Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial.  Gastroenterology. 2003;  125 668-676
  • 71 Tam W C, Schoeman M N, Zhang Q. et al . Delivery of radiofrequency energy to the lower oesophageal sphincter and gastric cardia inhibits transient lower oesophageal sphincter relaxations and gastro-oesophageal reflux in patients with reflux disease.  Gut. 2003;  52 479-485
  • 72 Richards W O, Houston H L, Torquati A. et al . Paradigm shift in the management of gastroesophageal reflux disease.  Ann Surg. 2003;  237 638-647
  • 73 O’Connor K W, Lehman G A. Endoscopic placement of collagen at the lower esophageal sphincter to inhibit gastroesophageal reflux: a pilot study of 10 medically intractable patients.  Gastrointest Endosc. 1988;  34 106-112
  • 74 Lehman G A, Aisenberg J, Cohen L B. et al . Enteryx solution, a minimally invasive injectable treatment for GERD: international multicenter trial results [abstract].  Gastroenterology. 2002;  122 A602
  • 75 Lehman G A, Hieston K J, Johnson D. et al . Enteryx solution, a minimally invasive injectable treatment for GERD: analysis of pH-metry and manometry findings over 12 months [abstract].  Gastroenterology. 2003;  124 A1734
  • 76 Aisenberg J, Johnson D, Cohen L. et al . Enteryx solution, a minimally invasive injectable treatment for GERD: analysis of X-ray findings over 12 months [abstract].  Gastroenterology. 2003;  124 A1730
  • 77 Neuhaus H, Schumacher B, Preiss C. et al . Enteryx solution, a minimally invasive injectable treatment for GERD: German multicenter experience [abstract].  Gastroenterology. 2003;  124 A1744
  • 78 Ganz R, Aisenberg J, Cohen L. et al . Enteryx solution, a minimally invasive injectable treatment for GERD: analysis of endoscopy findings at 12 months [abstract].  Gastroenterology. 2003;  124 A1743
  • 79 Lehman G A, Hieston K J, Aisenberg J. et al . Enteryx solution, a minimally invasive injectable treatment for GERD: current worldwide multi-center human trial results [abstract].  Gastroenterology. 2003;  124 A672
  • 80 Fockens P, Bruno M J, Boeckxstaens G E, Tytgat G. Endoscopic removal of the Gatekeeper system prosthesis [abstract].  Gastroenterology. 2002;  122 A1591
  • 81 Gabbrielli A, Emerenziani S, Cicala M. et al . Endoscopic insertion of hydrogel expandable stent in esophageal submucosa in patients with GERD: the Gatekeeper system experience in 10 patients with 6 months of follow-up [abstract].  Dig Liver Dis. 2003;  35 Suppl 4 S41
  • 82 Metrangolo S, Bertini M, Beroni M. et al . Endoscopic implant of Enteryx in GERD [abstract].  Dig Liver Dis. 2003;  35 Suppl 4 S53
  • 83 Deviere J, Cohen L B, Aisenberg J. et al . Predictors of Enterix outcomes at 12 months [abstract].  Gastroenterology. 2004;  126 A922
  • 84 Johnson D A, Aisenberg J, Cohen L B. et al . Enterix - 24 months clinical safety and effectiveness.  Gastroenterology. 2004;  126 A468
  • 85 Fockens P, Boeckxtaens G E, Gabbrielli A. et al .Gastroenterology 2004. 126: A921
  • 86 Johnson D A, Ganz R, Aisenberg J. et al . Endoscopic implantation of Enteryx for treatment of GERD: 12-month results of a prospective, multicenter trial.  Am J Gastroenterol. 2003;  98 1921-1930
  • 87 Deviere J, Pastorelli A, Louis H. et al . Endoscopic implantation of a biopolymer in the lower esophageal sphincter for gastroesophageal reflux: a pilot study.  Gastrointest Endosc. 2002;  55 335-341
  • 88 Feretis C, Nenakis P, Domopoulos C. et al . Endoscopic treatment of Plexigas (PNMA) microspheres for the treatment of GERD.  Gastrointest Endosc. 2001;  53 423-426
  • 89 Fockens P, Bruno J M, Gabbrielli A. et al . Endoscopic augmentation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease: multicenter study of the Gatekeeper reflux repair system.  Endoscopy. 2004;  36 682-689
  • 90 Tintillier M, Chaput A, Kirch L. et al . Esophageal abscess complicating endoscopic treatment of refractory gastroesophageal reflux disease by Enteryx injection: a first case report.  Am J Gastroenterol. 2004;  99 1856-1858
  • 91 Rothstein R I . Endoscopy therapy for gastroesophageal reflux disease.  Gastrointest Endosc Clin N Am. 2003;  13 1-226
  • 92 Arts J, Tack J, Galmiche J P. Endoscopic antireflux procedures.  Gut. 2004;  53 1207-1214
  • 93 Kahrilas P J. Radiofrequency energy treatment of GERD.  Gastroenterology. 2003;  125 970-973

1 These authors contributed equally to the preparation of the manuscript

2 These authors were involved equally in the critical review of the final draft

V. Annese, M.D.

U.O. Gastroenterologia · Ospedale CSS-IRCCS

Viale Cappuccini 1 · 71013 San Giovanni Rotondo · Italy

Fax: +39-882-411879/705

Email: v.annese@operapadrepio.it

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