ASGE Esophagology: Tailoring Management from Testing to Treatment (Live and Virtual) | July 2022-Olaya Gutierrez

Olaya Gutierrez_Endsocopic-Surgical GERD

Pdf Summary

This document discusses minimally invasive endoscopic and surgical treatments for gastroesophageal reflux disease (GERD). It begins by mentioning that while proton pump inhibitors (PPIs) are the first-line therapy for GERD, a significant number of patients do not have a complete or successful response to PPIs. Alternative therapies may be considered for patients who have persistent symptoms or esophagitis despite daily PPI use, are intolerant to PPIs, or want to avoid long-term PPI use. <br /><br />The document then discusses various endoscopic therapies for GERD, including radiofrequency therapy (Stretta), transoral fundoplication (TIF), mucosal resection/ablation, and banding. It provides some information on the mechanisms and results of these therapies from various studies and meta-analyses. <br /><br />Next, it discusses surgical anti-reflux therapies, specifically laparoscopic fundoplication (Nissen, Toupet) and magnetic sphincter augmentation (MSA). It compares the durability, reflux control, dysphagia, and other factors associated with these procedures. <br /><br />The document concludes by summarizing that PPIs are the most cost-effective therapy for GERD, but there is increased interest in alternative therapies. Endoscopic therapies may be useful for patients with breakthrough symptoms on PPIs or those reluctant to take long-term PPIs. Surgical fundoplication (LARS) remains the gold standard therapy for refractory GERD. However, further research is needed to determine the best therapy for individual patients.

Keywords

minimally invasive

endoscopic treatments

surgical treatments

gastroesophageal reflux disease

proton pump inhibitors

alternative therapies

persistent symptoms

laparoscopic fundoplication

reflux control

gold standard therapy