Abstract
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases encountered in primary care and gastroenterology clinics. Most cases of GERD can be diagnosed based on clinical presentation and risk factors; however, some patients present with atypical symptoms, which can make diagnosis difficult. An esophagogastroduodenoscopy can be used to assist in diagnosis of GERD, though only half of these patients have visible endoscopic findings on standard white light endoscopy. This led to the development of new advanced endoscopic techniques that enhanced the diagnosis of GERD and related complications like squamous cell dysplasia, Barrett's esophagus, and early esophageal adenocarcinoma. This is conducted by improved detection of subtle irregularities in the mucosa and vascular structures through optical biopsies in real-time. Management of GERD includes lifestyle modifications, pharmacological therapy, endoscopic and surgical intervention. Minimally invasive endoscopic intervention can be an option in selected patients with small hiatal hernia and without complications of GERD. These endoscopic interventions include endoscopic fundoplication, endoscopic mucosal resection techniques, ablative techniques, creating mechanical barriers, and suturing and stapling devices. As these new advanced endoscopic techniques are emerging, data surrounding the indications, advantages and disadvantages of these techniques need a thorough understanding.
Highlights
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases of the western world, with increasing morbidity [1, 2]
A meta-analysis of 11 studies showed that Narrow-band imaging (NBI) has sensitivity and specificity of 0.91 and 0.85 on a per-patient, and 0.97 and 0.64 on a per-lesion basis for specialized intestinal metaplasia diagnosis in the Barrett’s esophagus, respectively
Newer advanced endoscopic imaging and intervention techniques can improve the diagnostic accuracy of GERD and could improve target biopsy samples from high yield areas
Summary
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases of the western world, with increasing morbidity [1, 2]. A meta-analysis of 11 studies showed that NBI has sensitivity and specificity of 0.91 (95% CI: 0.86–0.94) and 0.85 (95% CI: 0.76–0.92) on a per-patient, and 0.97 (95% CI: 0.95–0.98) and 0.64 (95% CI: 0.59–0.68) on a per-lesion basis for specialized intestinal metaplasia diagnosis in the Barrett’s esophagus, respectively. Esophageal capsule endoscopy (ECE) was approved in 2004 to evaluate esophagus in patients with GERD and suspected Barrett’s esophagus by Food and Drug Administration (FDA) It uses a video capsule endoscope, which has a camera at both ends. Most adverse events occurred during the first 6 months, which resolved without long-term sequelae [48] (Table 3) In another multicenter trial, 64 patients with GERD on PPI were assigned to the Enteryx R implantation (n = 32) group and sham procedure consisting of standard EGD (n = 32) group. Removed from market due to poor long-term results Not approved by FDA for GERD treatment
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