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Role of endoscopy in gastroesophageal reflux disease

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초록

In general, gastroesophageal reflux disease (GERD) is diagnosed clinically based on typical symptoms and/or response to proton pumpinhibitor treatment. Upper gastrointestinal endoscopy is reserved for patients presenting with alarm symptoms, such as dysphagia,odynophagia, significant weight loss, gastrointestinal bleeding, or anorexia; those who meet the criteria for Barrett’s esophagus screen-ing; those who report a lack or partial response to proton pump inhibitor treatment; and those with prior endoscopic or surgical an-ti-reflux interventions. Newer endoscopic techniques are primarily used to increase diagnostic yield and provide an alternative to med-ical or surgical treatment for GERD. The available endoscopic modalities for the diagnosis of GERD include conventional endoscopywith white-light imaging, high-resolution and high-magnification endoscopy, chromoendoscopy, image-enhanced endoscopy (nar-row-band imaging, I- SCAN, flexible spectral imaging color enhancement, blue laser imaging, and linked color imaging), and confocallaser endomicroscopy. Endoscopic techniques for treating GERD include esophageal radiofrequency energy delivery/Stretta procedure,transoral incisionless fundoplication, and endoscopic full-thickness plication. Other novel techniques include anti-reflux mucosecto-my, peroral endoscopic cardiac constriction, endoscopic submucosal dissection, and endoscopic band ligation. Currently, many of thenew endoscopic techniques are not widely available, and their use is limited to centers of excellence.

Abstract

In general, gastroesophageal reflux disease (GERD) is diagnosed clinically based on typical symptoms and/or response to proton pumpinhibitor treatment. Upper gastrointestinal endoscopy is reserved for patients presenting with alarm symptoms, such as dysphagia,odynophagia, significant weight loss, gastrointestinal bleeding, or anorexia; those who meet the criteria for Barrett’s esophagus screen-ing; those who report a lack or partial response to proton pump inhibitor treatment; and those with prior endoscopic or surgical an-ti-reflux interventions. Newer endoscopic techniques are primarily used to increase diagnostic yield and provide an alternative to med-ical or surgical treatment for GERD. The available endoscopic modalities for the diagnosis of GERD include conventional endoscopywith white-light imaging, high-resolution and high-magnification endoscopy, chromoendoscopy, image-enhanced endoscopy (nar-row-band imaging, I- SCAN, flexible spectral imaging color enhancement, blue laser imaging, and linked color imaging), and confocallaser endomicroscopy. Endoscopic techniques for treating GERD include esophageal radiofrequency energy delivery/Stretta procedure,transoral incisionless fundoplication, and endoscopic full-thickness plication. Other novel techniques include anti-reflux mucosecto-my, peroral endoscopic cardiac constriction, endoscopic submucosal dissection, and endoscopic band ligation. Currently, many of thenew endoscopic techniques are not widely available, and their use is limited to centers of excellence.

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