Antireflux Surgery: State of the Art From Diagnosis to Treatment

Abstract

Background: Gastroesophageal reflux (GERD) disease is a common condition. It is caused by different underlying causes, ranging from lower oesophageal sphincter (LOS) dysfunction to an impaired gastric emptying and esophageal motility disorders. Although initially representing a benign condition, persistent GERD can result in precancerous lesions. Over time, various surgical and endoscopic solutions have been proposed, particularly for patients in whom medical therapy is either ineffective or poorly tolerated. Both endoscopic and surgical techniques aim to enhance the function of the anti-reflux barrier.

Methods: We provided an extensive narrative review of the diagnosis and treatment of GERD treatment, exploring both endoscopic and surgical solutions.

Results: Endoscopic procedures generally involve techniques such as gastric plication, delivery of radiofrequency energy at the gastroesophageal junction (EGJ), and the injection bulking agents into the EGJ.

Conclusions: The efficacy of endoscopic treatments is not yet supported by robust scientific evidence. To date surgical fundoplication remains the gold standard for the treatment of GERD.

Keywords: antireflux endoscopy; antireflux surgery; fundoplication; gastroesophageal reflux; hiatal hernia.