Endoscopic Fundoplication for GERD

Patient Selection Criteria for Approval

The American Gastroenterological Association recommends that patients must have confirmatory evidence of pathologic GERD through objective testing before considering any invasive anti-reflux procedure 3
Complete endoscopic evaluation should document the presence or absence of erosive esophagitis, diaphragmatic hiatus assessment, axial hiatal hernia length, and inspection for Barrett's esophagus 3
Patients with regurgitation-predominant symptoms, which often respond better to mechanical anti-reflux procedures, are considered appropriate candidates for endoscopic fundoplication 2, 4
The American College of Gastroenterology recommends that patients with normal esophageal peristaltic function confirmed by manometry are suitable candidates for endoscopic fundoplication 3, 4

Patients with severe erosive esophagitis (Los Angeles grade C or D) are not suitable candidates for endoscopic fundoplication 5, 6
The American Gastroenterological Association recommends that patients with esophageal motility disorders or impaired peristaltic function should not undergo endoscopic fundoplication 3, 4
Patients with Barrett's esophagus or other GERD complications are not suitable candidates for endoscopic fundoplication 5, 6

Symptom improvement is significant but normalization of acid exposure is less consistent following endoscopic fundoplication 5, 6
The American College of Gastroenterology recommends that long-term durability beyond 1-2 years remains unclear for most endoscopic techniques 5, 6
Previous endoscopic anti-reflux devices have been withdrawn from the market due to safety concerns or lack of efficacy 5, 6

The American Gastroenterological Association recommends confirming GERD diagnosis with objective testing (endoscopy, pH monitoring) before proceeding with endoscopic fundoplication 3
Ensuring optimal medical therapy has been attempted (PPI trial for 4-8 weeks) is crucial before considering endoscopic fundoplication 1
Evaluating predominant symptom pattern (regurgitation vs. heartburn) is essential in determining suitability for endoscopic fundoplication 2, 4
Considering patient preferences regarding long-term PPI use versus procedural intervention is important in the decision-making process for endoscopic fundoplication 1