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Postgraduate Course at DDW: Complete Clinical Upda ...
3_Sun Canto endo therapies for GERD
3_Sun Canto endo therapies for GERD
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Pdf Summary
Dr. Mimi Canto, a professor at Johns Hopkins University, provides an in-depth overview of the endoscopic management of Gastroesophageal Reflux Disease (GERD). In her presentation, she highlights the significance of understanding the anti-reflux barrier's components, patient selection for endoscopic treatments, and the various therapies available.<br /><br />Key disclosures include Dr. Canto's research grants and consulting roles with companies such as Pentax Medical Corporation and Castle Biosciences. Her objectives are to elucidate the components of the anti-reflux barrier, discuss patient selection criteria for endoscopic GERD treatments, and provide an overview of endoscopic GERD therapies.<br /><br />The presentation covers surgery and endoscopy's role in managing the condition, including reducing hiatal hernias and augmenting the lower esophageal sphincter (LES). Classification systems, like Hill and the American Foregut Society (AFS), help evaluate the gastroesophageal junction's (GEJ) integrity, aiding in diagnostic accuracy.<br /><br />Patient selection considers several factors, including age, GEJ anatomy, BMI, GERD phenotype, symptom severity, esophageal motility, and patient preferences.<br /><br />Current endoscopic GERD therapies include procedures that augment the LES and the GEJ flap valve, such as Stretta, CLEAR, PECC-b, ARMS, and GERD-X. Specific attention is given to Transoral Incisionless Fundoplication (TIF), detailing its efficacy in reducing acid exposure and improving patient quality of life.<br /><br />Candidates suitable for TIF include those with troublesome regurgitation or heartburn, small hiatal hernias, and Hill grades 1 or 2, aiming to avoid long-term PPI use.<br /><br />In conclusion, endotherapy for GERD is evolving, offering promising alternatives or complements to traditional medical and surgical approaches. Dr. Canto emphasizes the importance of shared decision-making and selecting suitable therapies for individual patient needs.
Keywords
Gastroesophageal Reflux Disease
GERD
endoscopic management
anti-reflux barrier
patient selection
Transoral Incisionless Fundoplication
endoscopic therapies
lower esophageal sphincter
hiatal hernia
shared decision-making
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