The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endoscopic augmentation of the lower oesophageal sphincter using hydrogel implants for the treatment of gastro-oesophageal reflux disease in June 2007. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

The guidance was considered for reassessment in June 2010 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.


An overtube and implant delivery mechanism is endoscopically guided to the gastro-oesophageal junction. Suction is applied to pull a fold of the oesophageal wall into the overtube. Saline is injected into this fold to create a space within the submucosa, and one or more hydrogel prostheses are implanted. The prostheses absorb water and expand to create a fold in the oesophageal wall bulking the oesophagus and preventing gastro-oesophageal reflux.

Coding recommendations

G44.1 Fibreoptic endoscopic insertion of prosthesis into upper gastrointestinal tract

Includes: Endoscopic insertion of expanding metal stent into upper gastrointestinal tract

O11.1 Gastro-oesophageal junction