Endoluminal gastroplication for gastro-oesophageal reflux disease

Gastro-oesophageal reflux disease (GORD) is a common condition 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, chest pain and nausea, and those symptoms caused by complications of reflux disease, including problems swallowing (dysphagia) and respiratory symptoms. Repeat episodes of GORD can damage the lining of the oesophagus and lead to oesophageal ulceration, oesophageal stricture, and Barrett's oesophagus.

NICE's guideline on the investigation and management of gastro-oesophageal reflux disease and dyspepsia in adults makes recommendations for treatment. The standard treatments for symptomatic GORD are lifestyle modification and drug therapy. Drug therapy includes acid-lowering agents such as H2 receptor antagonists and proton pump inhibitors (PPIs). People with reflux symptoms that do not respond to medical treatment or who develop intolerance to medication may have anti-reflux surgery.

Surgical or laparoscopic fundoplication may be used, and minimally invasive treatments such as endoscopic radiofrequency ablation or endoscopic injection of bulking agents are available.

Different devices have been used for this procedure and exact details of the technique vary. The procedure is usually done with the patient under general anaesthesia. An endoscopic fastening device is inserted through the mouth and into the stomach, along with an endoscope for constant visualisation. The device is used to attach the fundus to the anterior and left lateral wall of the distal oesophagus slightly above the oesophagogastric junction.

With 1 of the devices, polypropylene fasteners are delivered through apposed layers of oesophageal and fundus tissue to anchor the repair. About 20 fasteners are implanted during the procedure to create a full thickness, partial circumference, gastro-oesophageal fundoplication. The aim is to recreate a valve and form a barrier to reflux. Endoluminal gastroplication for gastro-oesophageal reflux disease aims to reduce the morbidity associated with open or laparoscopic fundoplication.