Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-3

3_Sun Canto endo therapies for GERD

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