Published September 2022
Endoscopic treatments can effectively control gastroesophageal reflux disease in appropriate patients
Gastroesophageal reflux disease (GERD) is one of the most commonly diagnosed gastrointestinal disorders. In GERD, stomach acid repeatedly flows back into the esophagus – the tube connecting the mouth and stomach – irritating and potentially damaging the lining of the esophagus over time.
While occasional acid reflux is common, when it happens frequently, it is called GERD. Risk factors for this condition include obesity; a hiatal hernia, which causes the top of the stomach to bulge above the diaphragm; pregnancy; connective tissue disorders; delayed stomach emptying; and lifestyle factors like smoking, eating overly large meals or eating before bed, regular consumption of fatty or fried foods, drinking alcoholic beverages or coffee, and taking certain medications.
While most people with GERD take medications to control their condition, and some people need surgery, there have been many devices created and ideas proposed to treat reflux disease endoscopically. Several devices have been tried and even FDA approved, but they are no longer used. There is a clear need for effective reflux control with lower risk and faster recovery, so William Richardson, MD, Section Head for General, Laparoscopic, Bariatric, Acute Care and Oncologic Surgery and Program Director of the Ochsner Surgical Weight Loss Program, assisted by General/Bariatric Surgeon Jessica Koller Gorham, MD, and Surgical Resident Nicole Neal, MD, examined the efficacy of an endoscopic suturing device (TIF), radiofrequency device (Stretta) and a promising newer technique called antireflux mucosectomy.
Their research, published in Advances in Surgery, showed that TIF, Stretta and antireflux mucosectomy reduced the need for pharmacologic therapy and effectively controlled GERD symptoms. The team determined that these endoscopic treatments are safe alternatives to medications and surgical procedures for most patients without certain contraindications. These contraindications include hiatal hernia over 2 centimeters or esophageal conditions like stricture, erosive esophagitis, esophageal dysmotility or Barrett esophagus.
The researchers believe that, as GERD is so prevalent, a shift to these techniques for appropriate patients is likely to improve patient care.
