Endoscopic Fundoplication for Gastroesophageal Reflux Disease (GERD)

Patient Selection and Diagnostic Criteria

The American Gastroenterological Association recommends that endoscopic fundoplication should only be considered in patients with confirmed diagnosis of pathologic GERD through objective testing, small or no hiatal hernia, normal esophageal peristaltic function, and absence of achalasia or other esophageal motility disorders 1, 2
Ideal candidates for endoscopic fundoplication include patients with regurgitation-predominant GERD 3, 4

A complete endoscopic evaluation should assess for erosive esophagitis, diaphragmatic hiatus, axial hiatal hernia length, and Barrett's esophagus 1, 2, 3
Ambulatory reflux monitoring, including prolonged wireless pH monitoring off PPI therapy and 24-hour pH-impedance monitoring on PPI, should be performed to confirm GERD diagnosis 1, 2, 5
High-resolution manometry should be used to exclude achalasia and assess esophageal peristaltic function 2
Endoscopic fundoplication has demonstrated improvement in GERD symptoms and quality of life, particularly in patients with regurgitation-predominant GERD 3, 4

Endoscopic fundoplication is a less invasive option compared to surgical fundoplication, with fewer side effects like dysphagia and gas bloating, but may have limited long-term durability data 2, 6
For obese patients with GERD, Roux-en-Y gastric bypass is more effective as a primary anti-reflux intervention, while sleeve gastrectomy should be avoided as it may worsen GERD 2, 3
Potential complications of endoscopic fundoplication include gastric mucosal tears and bleeding, but are generally less severe than those associated with surgical fundoplication 2, 6

The TIF procedure should be performed under general anesthesia and requires both a surgeon and an endoscopist 1, 2
Patients should be monitored for symptom resolution, quality of life improvement, and potential need for continued PPI therapy or more definitive surgical intervention if symptoms recur 1, 2