Lifetime management goals of
gastroesophageal reflux disease (
GERD) are to control esophageal as well as extraesophageal symptoms, maintain a stable noninflamed esophageal mucosa, and prevent complications. Large randomized clinical trials and >16 years of worldwide experience have confirmed the high rate of efficacy and excellent safety profile of
proton pump inhibitor (PPI)
therapy in individuals with all grades of
GERD, making these agents the mainstay of treatment. Despite these outcomes, some individuals may desire an alternative to pharmacologic
therapy. In such patients, laparoscopic
fundoplication may produce symptom relief and healing of
esophagitis, but its invasiveness, cost, and inherent surgical risks have created an interest in a variety of endoscopic
therapies for reflux disease. Several short-term uncontrolled trials of these endoscopic
therapies have reported encouraging preliminary results; however, careful patient selection as well as clinician experience is critical for their success. In addition to clinician expertise with the procedure, success has been observed only in patients with nonerosive
GERD and a
hiatal hernia <3 cm, abnormal pH monitoring, and normal esophageal motility studies, as well as in those who have experienced at least partial symptom relief with PPI
therapy. Endoscopic
therapy should not be considered the standard of care in patients with erosive disease or large
hiatal hernias.