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Gastroesophageal Reflux Disease
Another endoscopic procedure, known as the Stretta procedure, involves advantage, they all require further study to determine the long-term
delivering radiofrequency energy to the smooth muscle of the gastro- outcomes of the procedures and comparison with laparoscopic antireflux
esophageal junction. This technique effectively causes scarring and increased surgery. Many of the current studies are prospective trials that do not
LES pressure. A 2001 Vanderbilt study demonstrated favorable results, employ randomization. Furthermore, some of the studies have varied flaws
indicating that the procedure was safe, required a short learning curve, in their design that require further analysis.
36
improved patient quality of life, and decreased PPI usage.
30
A follow-up study
from this same group noted continued patient satisfaction, decreased distal Conclusion
acid exposure, and decreased PPI usage at an average two-year follow-up.
31,32
It is evident that GERD is a prominent and costly disease in the US.
Our group has shown that this procedure is particularly useful in the bariatric Furthermore, the incidence of BE has increased dramatically over the last
population. In most cases, Roux-en-Y gastric bypass (RYGBP) attenuates a 20 years, making the transition to esophageal adenocarcinoma more likely
number of the comorbidities of obesity, including GERD. However, a small in a greater portion of today’s population. Frequently, although PPIs are the
subpopulation may continue to be symptomatic even after weight loss. The primary mode of medical management they are not sufficient, and patients
Stretta procedure completely resolved GERD symptoms and normalized continue to be symptomatic. In addition, patients who are morbidly obese
esophageal pH in the majority of patients studied.
33
This study revealed an and have GERD may be best served with a gastric bypass as a primary
alternate approach to post-RYGBP patients who continue to have GERD. means of treatment. In patients diagnosed with BE, early surgical referral
should be considered, as recent evidence would suggest a halt or even a
Endoscopic injection of co-polymers into the gastric tissue to increase LES reversal of the intestinal metaplasia/dysplasia. Therefore, antireflux surgery
pressure has also been studied. The co-polymer injection, which causes a may better prevent the transition to esophageal adenocarcinoma
localized chronic inflammatory response with subsequent encapsulation of compared with medical management. In addition, as antireflux surgery
the co-polymer implantation, allowed for decreased usage of PPIs post- becomes more prominent, less invasive techniques continue to be
operatively and decreased symptoms of heartburn. However, a co-polymer developed. In spite of the appeal of endoluminal forms of antireflux
injection did not significantly decrease esophageal acid reflux as measured surgery, their long-term effectiveness in the prevention of GERD has not
by pH monitors.
34,35
In spite of these results, the co-polymer injection system been fully elucidated. Moreover, they have not been compared with
was recalled by the manufacturer due to serious and potentially life- laparoscopic fundoplication, which remains the gold standard. Finally,
threatening complications associated with its use.
36
further studies on patient outcomes and the prevention of BE and
adenocarcinoma need to be explored. Until those aspects have been
All of the endoluminal methods of treating GERD are valid methods that characterized, laparoscopic fundoplication should remain as the mainstay
may further minimize the invasiveness of antireflux surgery. Despite this of surgical antireflux therapy. ■
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64 US GASTROENTEROLOGY
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