Emerging Endoscopic Treatments for GERD

Gastroesophogeal reflux disease (GERD) is a common condition estimated to affect 60% of the adult population in the United States annually.¹ The condition can cause not only quality-of-life issues for patients, but also potentially lead to more serious conditions, including ulcerations of the esophagus and Barrett’s esophagus, which raises the risk for esophageal cancer.² Traditionally, GERD is treated using a combination of lifestyle changes and medication. But some patients also seek endoscopic treatment for the condition. Below, David A. Greenwald, MD, FASGE, spokesperson for the American Society for Gastrointestinal Endoscopy, discusses the advantages and disadvantages of these treatments.

New endoscopic treatments are now available for GERD. Can you please explain what these treatments involve and how they work in the management of GERD?
GERD has many causes, but frequently involves a muscular region known as the lower esophageal sphincter, the area where the esophagus and stomach join. This is commonly referred to as the gastroesophageal junction. When the lower esophageal sphincter becomes weaker or less effective, acid backs up from the stomach and refluxes into the esophagus, causing irritation. Typically, the first-line treatment for GERD includes lifestyle changes, such as avoiding offending foods, weight loss, or stopping smoking. These lifestyle changes are often supplemented with medication. The most commonly prescribed medications for GERD are a class of drugs called proton pump inhibitors. But some patients, particularly younger patients, typically between ages 30 and 50, may be worried by the prospect of staying on these drugs long-term, which is often necessary to prevent symptoms from returning. These patients sometimes opt instead for endoscopic treatment, which is an alternative to drug therapy.

Endoscopic treatments work by tightening the region in and near to the esophageal sphincter, which reduces the amount of acid passing from the stomach to the esophagus. There are two main types of endoscopic devices used for this purpose. The first type of device is inserted through the mouth into the esophagus to deliver radiofrequency waves, heating the tissue in the region of the lower esophageal sphincter. The heat is delivered through wire barbs at the end of the tool, injuring the underlying muscle and tissue and prompting scar tissue to form, which fills and ultimately tightens the area.

The second type of endoscopic device allows the gastroenterologist to place sutures, tightening the region of the gastroesophageal junction, a procedure generally known as gastric fundoplication. The procedure is designed to narrow the opening between the esophagus and the stomach, lessening reflux.

What are the advantages and disadvantages of endoscopic treatments compared with traditional pharmacological treatments?
Treating GERD endoscopically allows many patients to stop medication therapy completely, or to greatly reduce their dose. Proton pump inhibitors, which are the most common drugs used to treat GERD, are very safe in general, but may have substantial side effects, including an increased incidence of:

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