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Endoscopic Management of Reflux

Hiran Fernando, Josh Stodghill
Endoscopic Management of Reflux is a topic covered in the Pearson's General Thoracic.

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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
  • New therapies continue to be developed and brought to market. 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 surgical therapies. Endoscopic therapies for GERD were developed almost twenty years ago as an alternative to surgical therapy. Investigators hoped that they could somehow augment the reflux barrier with a simple endoscopic procedure. In the past decade advances in medical and surgical therapy of GERD have been significant. 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. Three approaches to endoscopic therapy have been developed: 1) radiofrequency ablation, 2) endoscopic plication or suturing, 3) injection or implantation techniques. Over the last decade, many trials have demonstrated efficacy in some of these procedures such as the transoral intraluminal fundoplication (TIF) procedure. This chapter is a review of the history, pathophysiology, and various mechanisms of endoscopic management of reflux.

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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
  • New therapies continue to be developed and brought to market. 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 surgical therapies. Endoscopic therapies for GERD were developed almost twenty years ago as an alternative to surgical therapy. Investigators hoped that they could somehow augment the reflux barrier with a simple endoscopic procedure. In the past decade advances in medical and surgical therapy of GERD have been significant. 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. Three approaches to endoscopic therapy have been developed: 1) radiofrequency ablation, 2) endoscopic plication or suturing, 3) injection or implantation techniques. Over the last decade, many trials have demonstrated efficacy in some of these procedures such as the transoral intraluminal fundoplication (TIF) procedure. This chapter is a review of the history, pathophysiology, and various mechanisms of endoscopic management of reflux.

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Last updated: February 22, 2020