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Copyright ©The Author(s) 2021.
World J Gastroenterol. Oct 21, 2021; 27(39): 6601-6614
Published online Oct 21, 2021. doi: 10.3748/wjg.v27.i39.6601
Table 2 Summary of guidelines and consensus recommendations and invasive gastroesophageal reflux disease therapies
Society guidelines and year of publication
Indication for surgery
Strength of recommendation, level of evidence, and grade of consensus
Endoscopic anti-reflux therapy addressed
Guideline recommendation on endoscopic anti-reflux therapy
Strength of recommendation and level of evidence
ACG guidelines for diagnosis and management of GERD, 2013[2]Option for long-term treatmentQuality: High. Strength: StrongRadiofrequency, bulking agents, endoscopic suturingNot recommendedQuality: Moderate. Strength: Conditional
Generally not recommended in PPI-unresponsive patientsQuality: High. Strength: Strong
Refractory patients with objective evidence of ongoing reflux as the cause of symptomsQuality: Low. Strength: Conditional
EAES recommendations, 2014[22]Good response but dependent on long-term PPI therapy, after optimal risk-benefit discussionGrade: C. Consensus: 100%Radiofrequency (Stretta®), bulking agent injection (Enteryx®), plication (EndoCinch®, full-thickness plication, EsophyX®Not enough evidence available to recommend any as an alternative option to surgeryGrade of recommendation: B. Expert consensus: 100%
Total or partial refractoriness despite adequate PPI therapy in terms of dosage and intakeGrade: A. Consensus: 100%
Well-selected NERD patients and those with hypersensitive esophagusGrade: C. Consensus: 100%
American Society of Gastrointestinal Endoscopy: The role of endoscopy in the management of GERD, 2015[95]Not providedNot providedRadiofrequency (Stretta®) and transoral incisionless fundoplicationConsider in highly selected patients. No details on selection criteriaLow quality
Asia-Pacific consensus on refractory GERD management, 2016[23]Refractory symptoms with objectively documented GERDQuality: Moderate. Strength: Strong. Consensus: 100%NoneNot applicableNot applicable
World Gastroenterology Organisation Global Guidelines, 2017[24]Large hiatal hernia with volume-related reflux symptoms. Refractory esophagitis. Refractory symptoms documented as caused by GERD. Medication adverse effectsNot specifiedEndoscopic therapies in generalOnly in the context of clinical trialsNot specified
SAGES Guidelines on GERD surgical treatment, 2010, and on endoluminal anti-reflux treatments, 2017[21,34]Appropriately selected GERD patientsGrade ATransoral incisionless fundoplicationControl of symptoms in appropriately selected patients in the short term; appears to lose effectivenessQuality: Moderate. Strength: Strong
RadiofrequencyControl of symptoms in appropriately selected patients; long-term effect in appropriately selected patientsQuality: Moderate. Strength: Strong
USA expert panel (surgeons and advanced therapeutic endoscopists) recommendations on GERD management, 2020[25]PPI responders (complete or partial)Appropriate. Consensus: 87%-100%Transoral incisionless fundoplicationPPI responders (complete or partial), no hernia, any other scenarioAppropriate. Consensus: 93%
PPI responders (complete or partial) or nonresponders, significant hernia, any other scenarioNot appropriate
PPI nonresponder, no hernia and acid breakthrough, hypersensitivity or negative pH-impedance study for heartburnAppropriate. Consensus: 80%–93%
PPI nonresponder, no hernia, heartburn-hypersensitivity, or negative pH-impedance studyAppropriateness uncertain
PPI nonresponder, regurgitation, negative pH-impedance studyAppropriateness uncertain
PPI nonresponder, any other scenarioAppropriate. Consensus: 80%-100%
RadiofrequencyPPI responders (complete or partial) or nonresponders, no hernia, any scenarioAppropriateness uncertain
PPI responders (complete or partial) or nonresponders, significant herniaNot appropriate
ESGE guidelines on endoscopic management of gastrointestinal motility disorders, 2020[35]Not applicableNot applicableTransoral incisionless fundoplicationPossible role in mild GERD patients who are unwilling to take PPIs or undergo surgery. Against widespread useQuality: Moderate. Strength: Strong. Consensus: 92.8%
Medigus Ultrasonic Surgical EndostaplerInsufficient data. Use only in clinical trialsQuality: Low. Strength: Strong. Consensus: 100%
RadiofrequencyCan be considered in selected patients only, without erosive esophagitis and hiatal herniaQuality: Moderate. Strength: Weak. Consensus: 92.9%
Anti-reflux mucosectomyAgainst routine use in clinical practiceQuality: Low. Strength: Strong. Consensus: 100%
ESNM/ASNM consensus paper on management of refractory GERD, 2020[26]Refractory GERD symptoms in patients with proven GERDConsensus: 100%Transoral incisionless fundoplicationShort-term benefit in improving regurgitation in carefully selected patientsConsensus: 100%
RadiofrequencyVariable symptom improvement, limited objective improvement in acid burden or manometric esophagogastric junction featuresConsensus: 100%