Endoscopic Treatment

 Endoscopic treatments for gastroesophageal reflux disease (GERD) patients have been developed as an alternative to long-term use of medical therapy as well as, potentially, to surgical intervention, which is considerably more invasive. The ideal candidate for endoscopic treatment may get response from medical therapy but does not feel it fully addresses the symptoms and is either unwilling or unable to proceed to surgical therapy Patients receiving endoscopic therapy should have small and relatively insignificant, if any, hiatal hernias because large-hernia patients are not candidates for endoscopic treatment as it is currently performed. If a patient has severe erosive esophagitis where effective acid control is critical, endoscopic treatment is not the best primary therapy but it may serve as an excellent add-in to improve the efficacy of medical therapy with proton pump inhibitors (PPIs). Some GERD patients have on-going regurgitation despite relief of pyrosis with acid suppression, and endoscopic treatment may be of benefit to control this chronic bother. In short, from the experience seen so far, the best candidates for endoscopic GERD treatment are those with mild disease who do respond to acid suppression. Continued investigation is needed on the role of endoscopic therapies for other clinical situations.    

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