New endoscopic treatments for gastroesophageal reflux disease.

This article reviews the available endoscopic treatments for gastroesophageal reflux disease (GERD). Plicating gastric folds methods, like Bard's EndoCinch method (Endoscopic Gastroplication, ELGP method), NDO Surgical's Full-thickness Plicator method, and Wilson-Cook Medical's Endoscopic Suturing Device (ESD) method, are used to form new plications in the cardia. Alternatively, thermal tissue remodeling/neurolysis methods, like Curon Medical's Stretta System, can be used to denature the muscular layer of the lower esophageal sphincter (LES) region. Finally, bulking injection methods, like Boston Scientific's Enteryx Procedure and Medtronic's Gatekeeper Reflux Repair System, can be used to insert a foreign body into the LES region. All six methods resulted in the improvement of symptoms and acid reflux, but only the bulking injection methods caused an improvement of the manometric findings. Nevertheless, the improvement of symptoms and acid reflux seems to be much more important than the improvement of the manometric findings. The overall discontinuation of proton-pump inhibitor (PPI) use was about 70%. Thus, endoscopic treatments for GERD are still in the development phase. The efficacy, safety, durability, cost-effectiveness, indications, and possible combination with other treatments must be thoroughly assessed in randomized controlled trials. If the usefulness of endoscopic treatment is confirmed, however, a new minimally invasive treatment strategy for GERD will have been established.