Gastroesophageal reflux disease, or GERD, is characterized by a loss of integrity of the muscular sphincter at the top of the stomach, where the esophagus, or food tube, enters. This weakness of the lower esophageal sphincter allows stomach acid to flow into the esophagus, where it causes heartburn and may erode the surface of the esophagus. Endoscopic treatments involve placing an instrument with a camera on it through the mouth and into the esophagus to surgically tighten the sphincter.
Endoscopic Suturing
Endocinch is the name of a device developed by the Bard company and approved by the FDA in 2000. It functions as a tiny sewing machine at the tip of an endoscope. The surgeon uses it to sew pleats or folds into the stomach at the junction with the esophagus. These folds serve to tighten the sphincter, thus preventing reflux of stomach contents into the esophagus. This procedure is appealing when compared to a similar surgery performed laparoscopically through several small holes in the abdomen, whereby the stomach is wrapped over itself to tighten the sphincter. However, the success rate of endoscopic suturing versus laparoscopic fundoplication is still in question, according to a 2007 article in "Alimentary Pharmacology and Therapeutics."
Injections
One strategy for the endoscopic treatment of gastroesophageal reflux disease is to inject a substance through the endoscope in to the stomach-esophagus junction to improve its integrity and functionality. However, attempts at developing such a procedure have been unsuccessful. The Enteryx procedure involved injection of a polymer into the muscle with the goal of tightening the sphincter. Unfortunately it was recalled by the manufacturer and its use discontinued due to excessive complications, notes the FDA. Another device called The Gatekeeper had the same outcome, according to the review article in "Alimentary Pharmacology and Therapeutics."
Radiofrequency Energy Application
This technique, also known as the Stretta procedure, involves a balloon deployed from the tip of the endoscope. When the balloon is inflated, four electrodes are inserted around the circumference of the stomach-esophagus junction. The application of radiofrequency waves through these electrodes theoretically results in scar tissue that narrows the opening to prevent reflux. Alternatively, it may reduce symptoms by impairing the nerves that carry the sensation of irritation to the brain, according to the University of Maryland Medical Center. There have been reports of perforation of the esophagus with this procedure, and it has not been shown to reduce acid levels in the esophagus, so it is not the best choice for all patients.
References
- "Alimentary Pharmacology and Therapeutics"; Review Article: The Endoscopic Treatment of Gastro-oesophageal Reflux Disease; M.P. Schwartz and A.J.P.M. Smout; December 2007
- University of Maryland Medical Center: Gastroesophageal Reflux Disease and Heartburn- Surgery
- California Pacific Medical Center: Procedure Profile - Diagnosis and Treatment Options for Gastroesophageal Reflux Disease (GERD)
- FDA: Safety Alert: Boston Scientific ENTERYX Procedure Kits and Injector Single Packs
