Health Problem: Gastroesophageal reflux disease (GERD) is the most common principal gastroenterology-related diagnosis in the United States, with 8.9 million diagnoses annually. GERD is the fifth most common hospital discharge diagnosis at 4.4 million.

Technology Description: Endoscopic therapy for GERD involves the use of a flexible endoscope placed transorally into the esophagus and stomach to facilitate procedures intended to improve the barrier to reflux. The 3 endoscopic therapies for GERD that are currently available in the United States are Stretta low-temperature radiofrequency energy (RF), EsophyX transoral incisionless fundoplication (TIF), and the Medigus Ultrasonic Surgical Endostapler (MUSE) endoscopic stapling (ES) system.

Controversy: With potential concerns about long-term use of proton pump inhibitors and the invasiveness of surgical fundoplication, several endoscopic devices and procedures have been investigated over the years. However, most of the devices have been withdrawn from the market due to safety issues or discontinued. One exception is Stretta, which has changed manufacturers at least 3 times since its inception. Two additional devices have recently been introduced, but more information is needed.

Key Questions

  • Are endoscopic therapies for GERD (i.e., RF with Stretta, TIF with EsophyX, ES with MUSE) effective?
  • Are endoscopic therapies for GERD safe?
  • What is the comparative effectiveness of RF, TIF, and ES?
  • Have definitive patient selection criteria been established for GERD patients treated with endoscopic therapy?

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