Endoscopic therapy for GERD: is the evidence for efficacy any stronger?

Gastroesophageal reflux disease (GERD) is a common chronic medical disorder that has a significant impact on quality of life and afflicts millions of people worldwide. Therapy with either daily medications or surgical fundoplication, though highly effective for the majority of patients, is not without long-term shortcomings. The development of endoscopic antireflux therapies has been fueled by the hope of providing safe, effective, long-term symptomatic relief. Although several studies have been published, they are limited by small sample size, lack of adequate controls, and a highly selective patient population. However, it is clear that many, if not most, patients will continue to be on acid-suppressive therapy despite these procedures. Also, reports of postmarketing adverse effects emphasize the need for further scrutiny of the safety of these devices. This review will summarize the available evidence and provide tentative conclusions about the current and evolving role of endoscopic antireflux therapy.