Endoscopic antireflux procedures.

The pathophysiologic hallmark of gastroesophageal reflux disease is loss of the physical barrier at the gastroesophageal junction (GEJ). In recent years, endoscopic techniques that augment or enhance the barrier have emerged. The various techniques include the injection of polymers at the GEJ, delivery of radiofrequency energy to the cardia, and by simple suturing or plication the gastroesophageal junction endoscopically. Results show significant symptomatic improvement, reduction in antacid medication usage, improvement in patient satisfaction, and modest reductions in esophageal acid exposure. Safety, feasibility, and efficacy have been shown with these endoscopic techniques. Future refinements and improvements are expected in this emerging field.