Endoskopische Antirefluxtherapien - was bleibt? - Transmurale Doppelnaht scheint am effektivsten

Abstract

Transmural double suture seems to be most effective – Endoscopic antireflux procedures: what remains? A couple of endoscopic antireflux procedures have been developed during the last years. Besides endoscopic suturing these techniques include injection or implantation of biopolymers and application of radio-frequency. Radiofrequency has proven only a very modest effect, while implantation techniques have been abandoned due to lack of long-term efficacy or serious side effects. While first generation endoluminal suturing techniques demonstrated a proof of principle, their lack of durability, due to suture loss, led to the development of a potentially durable transmural plication technique. In a prospective-randomized, sham-controlled trial the Plicator procedure proved superiority concerning reflux symptoms, medication use and esophageal acid exposure (24-hour pH-metry). Further technical improvements like the use of two joints are investigated and long-term data have to be awaited to draw final conclusions regarding the use of endoscopic procedures in reflux therapy.