Review Article

Antireflux Endoluminal Therapies: Past and Present

Table 1

Anti-reflux endoluminal therapies.

(1) Endoscopic fundoplication or suturing techniques

EndoCinchA landmark procedure approved by FDA in 2000 till today but the durability is poor even after enhanced modification
NDO PLICATORA full-thickness suturing transmural plicator to address the weakness of EndoCinch with successful creation of a more effective mechanical barrier but had been retrieved from market due to the company’s poor financial performance
EsophyxThis transoral incisionless fundoplication (TIF) has the advantage that it can reduce hiatal hernia up to 2 cm, which is often not possible with other anti-reflux endoluminal therapies. Serious complications such as esophageal perforation and postoperative bleeding were reported

(2) Injection/implantation techniques

Gatekeeper reflux repair system and Enteryx(1) Creation of an anti-reflux barrier by a bulking effect at LES which included injection of bovine dermal collagen, Teflon, polymethylmethacrylate microspheres (Plexiglas), and polytetrafluoroethylene (Polytef) with no remarkable benefits
(2) They were removed from the market due to unsatisfactory benefit from symptoms control or objective measurement of anti-reflux properties and various degrees of complications

(3) Radiofrequency ablation

Stretta system(1) It was first introduced in 2000 and utilizes an inflatable balloon-mounted device that introduces 4 electrodes at the LES with RFA energy delivered under controlled temperature to produce a coagulation inflammation, necrosis, and fibrosis. The technology has refined the recommended dosage to avoid serious complications
(2) It had gained popularity in recent years and is being used as a first line treatment option for refractory GERD before surgical salvage

FDA: food and drug administration; TIF: transoral incisionless fundoplication; LES: lower esophageal sphincter; RFA: radiofrequency ablation; GERD: gastroesophageal reflux disease.