Systematic review of endoscopic treatments for gastro-oesophageal reflux disease

Background: The aim of this review was to assess the safety and efficacy of endoscopic procedures for gastro-oesophageal reflux disease. Methods: Literature databases including Medline, Embase and PubMed were searched up to May 2006 without language restriction. Randomized controlled trials and non-randomized comparative studies with at least ten patients in each study arm, and case series studies of at least ten patients, were included. Results: A total of 33 studies examining seven endoscopic procedures (Stretta (R) procedure, Bard (R) EndoCinch (TM), Wilson-Cook Endoscopic Suturing Device, NDO Plicator (TM), Enteryx (R), Gatekeeper (TM) Reflux Repair System and Plexiglas (R)) were included in the review. Of the three procedures that were tested against sham controls (Stretta (R) procedure, Bard (R) EndoCinch (TM) and Enteryx (R)), patient outcomes in the treatment group were either as good as, or significantly better than, those of control patients in terms of heartburn symptoms, quality of life and medication usage. However, for the two procedures that were tested against laparoscopic fundoplication (Stretta (R) procedure and Bard (R) EndoCinch (TM)), outcomes for patients in the endoscopic group were either as good as, or inferior to, those for the laparoscopic group. Conclusion: At present there is insufficient evidence to determine the safety and efficacy of endoscopic procedures for gastro-oesophageal reflux disease, particularly in the long term.