Endoscopic GERD therapy: a primer for the transoral incisionless fundoplication procedure
| Autor: | Fateh Bazerbachi, Barham K. Abu Dayyeh, Kumar Krishnan |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Natural Orifice Endoscopic Surgery
medicine.medical_specialty Population Fundoplication law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Quality of life law Humans Minimally Invasive Surgical Procedures Medicine Radiology Nuclear Medicine and imaging Endoscopy Digestive System Intensive care medicine Adverse effect education education.field_of_study medicine.diagnostic_test business.industry Gastroenterology Proton Pump Inhibitors medicine.disease Endoscopy 030220 oncology & carcinogenesis Gastroesophageal Reflux GERD Current Procedural Terminology 030211 gastroenterology & hepatology business |
| Zdroj: | Gastrointestinal Endoscopy. 90:370-383 |
| ISSN: | 0016-5107 |
| Popis: | Patients with medically refractory GERD have the option of surgery but may opt for effective minimally invasive interventions, when available. However, the primary GERD pharmacologic therapy, proton pump inhibitors, does not satisfactorily address the pathophysiology of the disease. Moreover, a therapeutic gap exists in those severely symptomatic patients who fail medical management and who are poor candidates for surgical fundoplication. Recently, a revival of minimally invasive endoscopic interventions aiming to correct the antireflux barrier has followed existing device modifications, enhancing their safety and efficacy profile. Of these technologies, the trans-oral incisionless fundoplication (TIF) technique, in its current 2.0 iteration, has been studied in several randomized controlled trials with favorable outcomes and a low rate of adverse events. In this review, we discuss the landscape of endoscopic GERD therapy, focusing on recent updates in the TIF 2.0 procedure with the EsophyX-Z device (EndoGastricSolutions, Redmond, Wash, USA). We discuss the evolution, differences, and improvements in this technique across different generations of the EsophyX device. We also present a framework for candidate selection, based on medical and anatomic considerations. When streamlined within a milieu of comprehensive multidisciplinary programs, these improved endoscopic interventions can provide viable avenues for a carefully selected patients population, bridging therapy gaps, and selectively targeting the primary pathophysiology of the disease. |
| Databáze: | OpenAIRE |
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