Endoscopic antireflux procedures

Gastro-oesophageal reflux disease (GORD) is a common chronic disorder that has severe impact on quality of life. Moreover, GORD may also cause reflux oesophagitis and sometimes severe complications, such as ulceration, strictures, Barrett’s mucosa, and adenocarcinoma of the oesophagus.1 Surveys revealed that up to 15–20% of adults experience heartburn on a weekly basis and therefore the cost of drugs prescribed for the treatment of GORD represents a heavy economic burden for society.2 Although proton pump inhibitors (PPIs) are extremely effective in healing oesophagitis and improving typical reflux symptoms, they also have shortcomings and limitations.3 Firstly, they do not restore the normal antireflux barrier at the gastro-oesophageal junction and there is frequently a rebound acid hypersecretion after cessation of drug intake which both contribute to the high relapse rate observed after discontinuation of PPI therapy.4 Additionally, even though PPIs are usually extremely well tolerated drugs they can interact with Helicobacter pylori infection and occasionally be responsible for some rare side effects or drug interferences. In contrast with short term administration of H2 antagonists, PPIs are less potent in reducing nocturnal acid secretion.5 Finally, a challenging problem remains the treatment of the approximately 10–20% of patients with proven GORD who have only a partial or no response to high doses of PPIs.6 Laparoscopic fundoplication is often proposed as an alternative and more definitive option, especially in young patients, because it is intended to cure the disorder and the laparoscopic approach makes surgery more acceptable.7,8 Despite the high success rate of surgery in resolving typical reflux symptoms, substantial morbidity and some mortality exist. Complications such as dysphagia, inability to belch, diarrhoea, and flatulence may develop in up to 30% of patients.9 Recent publications tempered the enthusiasm for antireflux surgery. Spechler et al reported …