Gastroesophageal Reflux Disease - Clinical Practice Guidelines

Videosurgery and other miniinvasive techniques, 2009; 4 (Suppl 1)

ENDOSCOPIC TREATMENT: As a method with expected high efficacy and low complication rate, endoscopic treatment is gaining increasing popularity and is a subject of meticulous assessment of clinical efficiency. At the moment, only two methods are accepted by FDA: Stretta and EsophyX™. Recommendations for biopolymers have been withdrawn due to the substantial complication rate. EsophyX™ is a minimally invasive method of reflux disease treatment, and has recently been approved in the European Union for endoscopic fundoplication. The Stretta method uses radiofrequency energy on the LES and the subcardial area. This results in an increase of LES tension and muscular layer hypertrophy and decreases the number of transient sphincter relaxations. It is the only method with efficacy confirmed with randomized studies. Radiofrequency is also used for Barrett’s epithelium ablation with Halo 360 and Halo 90 apparatus. More traditional measures, such as endoscopic mucosectomy, argon or laser ablation, have been used for a much longer time. Any procedure of Barrett’s epithelium removal ought to be supplemented with surgical or endoscopic fundoplication.

SUMMARY: Reflux disease is a serious problem of not only medical, but also economic significance. The costs of long-term pharmacological treatment are tremendous. Surgical treatment for the majority of these patients seems justified. Such therapy ought to be undertaken in a centre with the volume exceeding 50 anti-reflux procedures per year. The procedure performed by an experienced surgeon gives a chance for remission of symptoms for over 5 years in more than 90% of patients. Application of laparoscopic techniques has made this method of treatment much more attractive.