Acta Scientific Gastrointestinal Disorders (ISSN: 2582-1091)

Review Article Volume 3 Issue 3

Endoscopic Prudence to Assess Gastro-Esophageal Junction (GEJ); A Necessity Rather a Prerequisite Prior to Endoscopic Anti-Reflux Treatment in Gastro-Esophageal Reflux Disease (GERD) Patients

Viswanath YKS*

Professor of Surgery, Consultant Upper GI and Laparoscopic Surgeon, Surgical Directorate, Endoscopy Offices, James Cook University Hospital, Cleveland, UK

*Corresponding Author: Viswanath YKS, Professor of Surgery, Consultant Upper GI and Laparoscopic Surgeon, Surgical Directorate, Endoscopy Offices, James Cook University Hospital, Cleveland, UK.

Received: January 31, 2020; Published: February 19, 2020

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  Gastroesophageal reflux disease (GERD) is a common condition affecting more than 30% of the western adult population. Its impact on the quality of life is a well-known entity especially in patients with moderate to severe GERD. In the long term, it can lead to Barrett’s metaplasia, dysplasia, and adenocarcinoma.

  The ‘triad of intrinsic lower esophageal sphincter (LES) function, extrinsic compression of crura (pinch valve effect) and acute angle of HIS’ are amongst a few main factors that contribute towards an effective antireflux barrier. Recent advances in technology have enabled to treat GERD in indicated cases via an endoscope as a day case on outpatient basis. The effectiveness and efficacy of these endoscopy interventions are primarily determined by accurate preintervention assessment and selection of these patients.

  Endoscopic fundoplication (EF) or Transoral incisionless fundoplication (TIF) and endoscopic radiofrequency (RF) antireflux therapy (STRETTA) are two well established day case procedures and evidence support that in selected cases, they impact positively on the improvement of efflux symptoms and dependency on PPI’s1. The Stretta primarily effects via augmentation of intrinsic LES function, while EF via creating a flap valve. Both are known to be effective in patients with small hiatus hernia without pathological crural dilatation (CD) [1]. Currently, there is no endoscopy technique that can correct pathological crural dilation (extrinsic factor) and sliding hiatus hernia (more than 2.5 cms). Therefore, it is prudent to assess the GE junction (GEJ) and chose the right patient prior to offering an endoscopic treatment. There is some evidence to support patient selection by means of an endoscopic gastroesophageal junction flap valve (GEJFV) grading system [2]. The GEJ assessment comprises anatomical (endoscopy and imaging) and physiological (manometry) evaluation in conjunction with Ph studies. This article highlights the importance of endoscopic assessment and poses a few questions on selection criteria prior to endoscopic antireflux therapy.

Keywords: Gastroesophageal Reflux Disease (GERD); Antireflux Therapy; Manometry

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Citation

Citation: Viswanath YKS. “Endoscopic Prudence to Assess Gastro-Esophageal Junction (GEJ); A Necessity Rather a Prerequisite Prior to Endoscopic Anti-Reflux Treatment in Gastro-Esophageal Reflux Disease (GERD) Patients”. Acta Scientific Gastrointestinal Disorders 3.3 (2020): 01-03.



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