Key Points

Endoscopic management of gastroesophageal reflux disease has evolved over the past 15 years

• After some initial enthusiasm some of the earlier approaches were abandoned due to poor results, procedure related complications and lack of insurance coverage
• A novel multidisciplinary approach to GERD using a combined laparoscopic hiatal hernia repair followed by same-session TIF, coined concomitant transoral incisionless fundoplication (cTIF) has emerged as a new approach to GERD.
• New therapies continue to be developed and brought to market such as the anti-reflux mucosectomy (ARMS) procedure. The transoral intraluminal fundoplication (TIF) technique is the most widely used endoscopic technique currently.

Gastroesophageal reflux disease (GERD) remains a common problem that can be managed with medical and/or surgical therapies. Endoscopic therapies for GERD were developed over thirty years ago as an alternative to surgical therapy. Investigators hoped that they could somehow augment the reflux barrier with a simple endoscopic procedure. In an attempt to meet the demands of patients who wish to manage GERD without daily medical therapy or extensive surgery, investigators pioneered new devices that would be used to endoscopically modify the reflux barrier in more complex ways. There are a number of prior endoscopic techniques that are no longer utilized, but that paved the way for current approaches and that have historical significance. Over the past decade, several studies have demonstrated the efficacy of transoral intraluminal fundoplication (TIF) which has emerged as the predominant endoscopic approach for GERD. There has also been a move towards a more multidisciplinary approach using a combined endoscopic and surgical approach with collaboration between gastroenterologists and surgeons combining laparoscopic repair of hiatal hernia in combination with TIF, known as concomitant transoral incisionless fundoplication (cTIF). Another emerging procedure is the anti-reflux mucosectomy (ARMS). This chapter reviews of the history, pathophysiology, mechanisms of endoscopic management of reflux, and the efficacy of these novel approaches.