Endoscopic Advances in the Diagnosis and Management of Gastroesophageal Reflux Disease

Abstract

Gastroesophageal reflux disease (GERD) is one of the most common diseases that occurs secondary to failure of the antireflux barrier system, resulting in the frequent and abnormal reflux of gastric contents to the esophagus. GERD is diagnosed in routine clinical practice based on the classic symptoms of heartburn and regurgitation. However, a subset of patients with atypical symptoms can pose challenges in diagnosing GERD. An esophagogastroduodenoscopy (EGD) is the most common initial diagnostic test used in the assessment for GERD, although half of these patients will not have any positive endoscopic findings suggestive of GERD. The advanced endoscopic techniques have improved the diagnostic yield of GERD diagnosis and its complications, such as Barrett's esophagus and early esophageal adenocarcinoma. These newer endoscopic tools can better detect subtle irregularities in the mucosa and vascular structures. The management options for GERD include lifestyle modifications, pharmacological therapy, and endoscopic and surgical interventions. The latest addition to the armamentarium is the minimally invasive endoscopic interventions in carefully selected patients, including the electrical stimulation of the LES, Antireflux mucosectomy, Radiofrequency therapy, Transoral Incisionless Fundoplication, Endoscopic Full-Thickness plication (GERDx™), and suturing devices. With the emergence of these advanced endoscopic techniques, it is crucial to understand their selection criteria, advantages, and disadvantages.

Keywords: FICE; GERD; I-scan; Narrow Band Imaging; endoscopy; esophageal capsule endoscopy; gastroesophageal reflux disease; transoral incisionless fundoplication.

Figure 1

Endoscopic management of GERD.

Figure 2

Endoscopic image of the gastroesophageal junction (GEJ) using the high-definition (HD) endoscopy.

Figure 3

Endoscopic image of the gastroesophageal junction (GEJ) using the Narrow Band Imaging (NBI).

Figure 4

Comparison of white light endoscopy (A) and i-scan with an irregular Z line and minimal-change GERD (B).

Figure 5

Transoral rotational esophagogastric fundoplication with gastrogastric plications placed proximal to the Z-line.

Figure 6

Cardia Ligation Endoscopic Anti-Reflux (CLEAR) procedure: (A) The assessment of cardia. (B) Capture of mucosa at the level of the gastroesophageal junction with the band ligation device. (C,D) Capture of mucosa one by one, oriented towards the lesser curvature of the stomach.