The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Endoscopic injection of bulking agents for gastro-oesophageal reflux disease.

As part of the NICE's work programme, the current guidance was considered for review but did not meet the review criteria as set out in the IP process guide. The guidance below therefore remains current.


Gastro-oesophageal reflux disease (GORD) is a common condition that can have a significant impact on the quality of life of an individual. It is caused by failure of the sphincter mechanism at the lower end of the oesophagus. Symptoms of GORD can be broadly grouped into those directly related to reflux episodes such as heartburn, regurgitation and waterbrash; and those symptoms caused by complications of reflux disease, including dysphagia and respiratory symptoms.

Drug therapy, combined with lifestyle modifications, is the standard treatment for patients with mild symptomatic GORD. Patients with more severe symptoms or oesophagitis may be treated with more intensive drug therapy and anti-reflux surgery may be needed.

The patient is sedated and given an injection of antibiotics. A needle catheter is then introduced through an endoscope into the gastro-oesophageal junction. This catheter is filled with a bio-compatible polymer and solvent and is used to inject or implant the polymer into the gastro-oesophageal junction. The injection is made along the muscle layer or deep submucosal layer of the cardia. Multiple injection/implants (often four) are performed in a circumferential manner around the oesophagus under fluoroscopic and endoscopic control.

Coding recommendations


SNOMED CT preferred term (concept ID)

Endoscopic injection of bulking agent to gastro-oesophageal junction (822391000000103)

G44.8 Other specified other therapeutic fibreoptic endoscopic operations on upper gastrointestinal tract

Y39.3 Injection of inert substance into organ NOC

Y53.4 Approach to organ under fluoroscopic control

O11.1 Gastro-oesophageal junction

Diagnosis or health condition

SNOMED CT preferred term (concept ID)

Gastroesophageal reflux disease (235595009)