PROPOSAL OF NOVEL ENDOSCOPIC DIAGNOSIS AND TREATMENT FOR GASTROESOPHAGEAL REFLUX DISEASE

Abstract

For the diagnosis of gastroesophageal reflux disease (GERD), the anti-reflux barrier (ARB) of the stomach and esophagus can be considered extramural or intramural. The extramural ARB includes the diaphragmatic hiatus and the esophageal diaphragmatic ligament. The intramural ARB comprises Phase I on the gastric side (collar sling muscle fibers and clasp muscle fibers), Phase Ⅱ on the esophageal side (LES), and Phase Ⅲ on the esophageal side (upper esophageal sphincter (UES) and peristalsis). This can be inferred by combining endoscopic pressure study integrated system (EPSIS) and high resolution manometry (HRM) to elucidate the pathophysiology of GERD. Regarding GERD, 70% of GERD cases are non-erosive gastroesophageal reflux disease (NERD), and most do not have a hernia. These conditions are good candidates for endoscopic anti-reflux surgery. The treatments range from anti-reflux mucosal resection (ARMS) to anti-reflux mucosal ablation (ARMA), anti-reflux mucoplasty, and anti-reflux mucoplasty with valve formation (ARM-PV). Evidence of the safety and efficacy of ARMS/ARMA has been reported in three systematic reviews. In the future, treatments are expected to develop along two main lines: the ideal pursuit of ARM-PV and the appealing technical simplicity of ARMA.