Bazerbachi F, Krishnan K, Abu Dayyeh BK.
Gastrointest Endosc. 2019 May 17. pii: S0016-5107(19)31720-1. doi: 10.1016/j.gie.2019.05.028. [Epub ahead of print]
Patients with medically refractory gastroesophageal reflux disease (GERD) have the option of surgery but may opt for effective minimally invasive interventions, when available. However, the primary GERD pharmacological therapy, proton pump inhibitors, does not satisfactorily address the pathophysiology of the disease. Moreover, a therapeutic gap exists in those severely symptomatic patients who fail medical management and who are poor candidates for surgical fundoplication. Recently, a revival of minimally invasive endoscopic interventions aiming to correct the antireflux barrier has followed existing device modifications, enhancing their safety and efficacy profile. Of these technologies, the Transoral Incisionless Fundoplication (TIF) technique, in its current 2.0 iteration, has been studied in several randomized controlled trials with favorable outcomes and a low rate of adverse events. In this exposition, we discuss the landscape of endoscopic GERD therapy, focusing on recent updates in the TIF 2.0 procedure with the EsophyX-Z device. We detail the evolution, differences, and improvements in this technique across different generations of the EsophyX device. We also present a framework for candidates selection, based on medical and anatomical considerations. When streamlined within a milieu of comprehensive multidisciplinary programs, these improved endoscopic interventions can provide viable venues for a carefully-selected patients population, bridging therapy gaps, and selectively targeting the primary pathophysiology of the disease.