Endoscopic management of gastroesophageal reflux disease (GERD) is being employed increasingly. A scoping review was published, assessing the volume of available evidence on the benefits of endoscopic and minimally invasive surgical therapies for GERD.
Criteria were used to perform an extensive literature search of data regarding the reported benefits of endoscopic therapies and GERD randomized control studies were utilized when available. However, data from observed observational studies were also reviewed.
A formal review of evidence was performed in 22 studies. Inclusion and exclusion criteria and study duration were noted and tabulated. Assessment of outcomes was based on symptoms and objective criteria reported by investigators reported outcomes for the interventions tabulated under the heading of subjective (symptom scores), quality of life metrics, and change in proton pump inhibitor use, objective metrics (pH parameters, endoscopic signs and lower esophageal sphincter pressure changes).
Adverse events were noted and tabulated. The majority of studies showed symptomatic and objective improvement of GERD with device therapies. Adverse events were minimal. However, normalization of acid exposure occurred in about 50% of patients and for some modalities, long-term durability is uncertain.
It was concluded that this scoping review revealed that the endoluminal and minimallyinvasive surgical devices for GERD therapy are a promising alternative to proton pump inhibitor therapy. Their place in the treatment algorithm for GERD will be better defined when important clinical parameters, especially durability of effect, are better understood.
Vaezi, M., Shaheen, N., Muthusamy, V. “State of Evidence in Minimally-Invasive Management of Gastroesophageal Reflux: Findings of a Scoping Review.” Gastroenterology 2020; Vol. 159, pp. 1504-1525.