Endoscopic therapies for the management of gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is a common disorder with rising incidence worldwide and very high medical costs to society. The medical management of the disease i.e. lifestyle modifications and proton pump inhibitors reaches excellent results in most cases, but it needs to be continued, lifelong; the real cure of the disease is nowadays laparoscopic fundoplication, which is effective and safe in over 95% of well selected patients to provide a durable high quality of life. A very attractive alternative to these well established therapies is the endoscopic treatment of GERD, that employs different endoluminal technologic skills: plication of gastric cardia folds by suturing devices, radiofrequencies thermal-induced cardial fibrosis and bulking or sclerosing agents local injections have been recently tried and validated by different very experienced endoscopic groups. Although endoscopic therapy of GERD seems to be safe and feasible, a definite judgement awaits the results of multicentric controlled studies and longer periods of follow-up; for the present they must be restricted to well experienced endoscopists working to these controlled trials.