Gastric fundoplication with endoscopic technique (GFET) is an innovative approach to managing gastroesophageal reflux disease (GERD). This minimally invasive procedure utilizes the GEN-2 Apollo endosuture device and Olympus H2T180 gastroscope to perform partial fundoplication by strategically placing Prolene 2-0 sutures at the 11, 7, 5, 1, and 3 o’clock positions around the gastroesophageal junction.

To evaluate whether GFET enhances the lower esophageal sphincter function by creating comprehensive plication to improve the barrier against reflux.

This single-center prospective study included patients undergoing GFET. Before beginning GFET, pH metrics and subsequent manometric measurements were obtained. An analysis of variance was performed to determine statistically significant differences between quality of life (QOL) and DeMeester scores at the time of the procedure and 6 and 12 months postoperatively. Pearson’s χ² test was performed to identify statistically significant differences between categorical variables at the time of the procedure and 6 and 12 months postoperatively.

Eighteen participants were enrolled (11 males and 7 females; mean age, 35 years). More than 70% had an initial Hill grade of IIb. One adverse event was recorded after the procedure. One patient underwent valve reinforcement at 12 months. The mean QOL score was markedly higher at the time of the procedure (39.9 ± 4.0) compared to those at 6 and 12 months postoperatively (P < 0.001). Scores at 12 months were slightly higher than those at 6 months. The highest mean QOL score was observed at the time of the procedure, followed by those at 6 and 12 months postoperatively (P < 0.001). A similar trend was noted for the mean DeMeester scores (P < 0.001).

GFET is a minimally invasive alternative to traditional surgical interventions and endoscopic techniques for managing GERD. Further research is warranted to validate its long-term efficacy and effectiveness over existing treatments.

• Gastric fundoplication with endoscopic technique
• Gastroesophageal reflux disease
• Therapeutic endoscopy

• endoscopic therapy
• endoluminal plication
• transoral incisionless fundoplication
• gastroesophageal reflux disease
• gerd
• radiofrequency ablation
• endoscopic suturing
• anti-reflux mucosectomy

• Humans
• Endoscopy
• Gastroesophageal Reflux/diagnosis

• P30 DK034854 NIDDK NIH HHS

Gastroesophageal reflux disease (GERD) is one of the most frequent gastrointestinal disorders. Proton pump inhibitors (PPIs) are effective in healing lesions and improving symptoms in most cases, although up to 40% of GERD patients do not respond adequately to PPI therapy. Refractory GERD (rGERD) is one of the most challenging problems, given its impact on the quality of life and consumption of health care resources. The definition of rGERD is a controversial topic as it has not been unequivocally established. Indeed, some patients unresponsive to PPIs who experience symptoms potentially related to GERD may not have GERD; in this case the definition could be replaced with “reflux-like PPI-refractory symptoms.” Patients with persistent reflux-like symptoms should undergo a diagnostic workup aimed at finding objective evidence of GERD through endoscopic and pH-impedance investigations. The management strategies regarding rGERD, apart from a careful check of patient's compliance with PPIs, a possible change in the timing of their administration and the choice of a PPI with a different metabolic pathway, include other pharmacologic treatments. These include histamine-2 receptor antagonists (H2RAs), alginates, antacids and mucosal protective agents, potassium competitive acid blockers (PCABs), prokinetics, gamma aminobutyric acid-B (GABA-B) receptor agonists and metabotropic glutamate receptor-5 (mGluR5) antagonists, and pain modulators. If there is no benefit from medical therapy, but there is objective evidence of GERD, invasive antireflux options should be evaluated after having carefully explained the risks and benefits to the patient. The most widely performed invasive antireflux option remains laparoscopic antireflux surgery (LARS), even if other, less invasive, interventions have been suggested in the last few decades, including endoscopic transoral incisionless fundoplication (TIF), magnetic sphincter augmentation (LINX) or radiofrequency therapy (Stretta). Due to the different mechanisms underlying rGERD, the most effective strategy can vary, and it should be tailored to each patient. The aim of this paper is to review the different management options available to successfully deal with rGERD.

• 24-h multichannel intraluminal impedance-pH (MII-pH)
• gastroesophageal reflux disease (GERD)
• laparoscopic antireflux surgery (LARS)
• proton pump inhibitors (PPIs)
• refractory GERD (rGERD)

• GERD
• emerging technology
• endoscopic therapy
• flexible endoscopy

• GERD
• Gastroesophageal reflux disease
• Nissen fundoplication
• Proton pump inhibitors

• Antireflux surgery
• Fundoplication
• Gastroesophageal reflux disease (GERD)
• Magnetic sphincter augmentation
• PPI-refractory

• Gastroesophageal Reflux/drug therapy
• Gastroesophageal Reflux/surgery
• Humans
• Proton Pump Inhibitors/therapeutic use
• Treatment Outcome

• R01 DK092217 NIDDK NIH HHS

• gastroesophageal reflux disease
• ppi refractory gerd
• fundoplication
• magnetic sphincter augmentation

• Decision Trees
• Digestive System Surgical Procedures/adverse effects
• Fundoplication/adverse effects
• Gastroesophageal Reflux/surgery
• Humans
• Laparoscopy/adverse effects
• Postoperative Complications/etiology

• R01 DK092217 NIDDK NIH HHS