New alternatives in the management of gastroesophageal reflux disease

Background: To date the mainstay of surgical treatment for gastroesophageal reflux disease (GERD) has been achieved with either open or laparoscopic fundoplication. Several new treatment modalities are attempting to augment the gastroesophageal (GE) junction function by various endoscopic means. Methods: The Medline database from 1980 to 2002 was searched for studies on endoscopic techniques for antireflux procedures. Product investigators were contacted for data presented in abstract form only. Results: Recent improvements in equipment and technique with excellent long-term follow-up have made laparoscopic Nissen fundoplication the gold standard in antireflux surgery. New techniques include using radiofrequency energy, injection of silicon type polymer and using endoluminal sutures to narrow the gastroesophageal junction. Early results have encouraging aspects, but should be evaluated thoroughly and with caution before widespread use. Conclusions: Endoscopic treatment of gastroesophageal reflux has future promise. However, more experience and perhaps further improvement in techniques and technology must occur before wide application can be encouraged.