Clinical Endoscopy

Original Article

The comparative study of Stretta radiofrequency and anti-reflux mucosectomy in the management of intractable gastroesophageal reflux disease: a single-center retrospective study from Korea: Ah Young Lee, Ji Woo Choi, Jeong Haeng Heo, Jun Young Chung, Seong Hwan Kim, Joo Young Cho; Clin Endosc 2025;58(3):409-417. Published online May 7, 2025; DOI: https://doi.org/10.5946/ce.2024.163

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Background
/Aims: Chronic gastroesophageal reflux disease (GERD) requires symptom relief and treatment of associated conditions. In this study, we aimed to compare anti-reflux mucosectomy (ARMS) and Stretta radiofrequency (SRF) for treating patients with chronic GERD who are unresponsive to proton pump inhibitors (PPIs) and to identify the indications for each procedure.
Methods
Data of patients who underwent ARMS or SRF between March 2021 and April 2023 were analyzed. Changes in GERD questionnaire (GERDQ) scores, endoscopic Los Angeles (LA) grade, flap valve grade (FVG) based on Hill’s type, EndoFLIP distensibility index (DI), endoscopic Barrett’s epithelium (BE) resolution rate, and PPI withdrawal rate were compared between the two groups.
Results
Improvements in the GERDQ scores and PPI withdrawal rates were similar between the groups. The ARMS group showed significantly better changes in endoscopic LA grade, FVG, and EndoFLIP DI than the SRF group. The complications were more prevalent in the ARMS group than in the SRF group.
Conclusions
The change in endoscopic LA grade before and after the procedure was significantly higher in the ARMS group than in the SRF group. Significant improvements in endoscopic FVG, BE resolution, and EndoFLIP DI were observed only with the ARMS group.

Citations

Citations to this article as recorded by

Redefining endoscopic management of refractory gastroesophageal reflux disease: the role of Stretta radiofrequency therapy and antireflux mucosectomy
Yuto Shimamura
Clinical Endoscopy.2025; 58(3): 398. CrossRef

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Review

Role of endoscopy in gastroesophageal reflux disease: Daniel Martin Simadibrata, Elvira Lesmana, Ronnie Fass; Clin Endosc 2023;56(6):681-692. Published online October 12, 2023; DOI: https://doi.org/10.5946/ce.2023.182

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In general, gastroesophageal reflux disease (GERD) is diagnosed clinically based on typical symptoms and/or response to proton pump inhibitor 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 screening; those who report a lack or partial response to proton pump inhibitor treatment; and those with prior endoscopic or surgical anti-reflux interventions. Newer endoscopic techniques are primarily used to increase diagnostic yield and provide an alternative to medical or surgical treatment for GERD. The available endoscopic modalities for the diagnosis of GERD include conventional endoscopy with white-light imaging, high-resolution and high-magnification endoscopy, chromoendoscopy, image-enhanced endoscopy (narrow-band imaging, I- SCAN, flexible spectral imaging color enhancement, blue laser imaging, and linked color imaging), and confocal laser 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 mucosectomy, peroral endoscopic cardiac constriction, endoscopic submucosal dissection, and endoscopic band ligation. Currently, many of the new endoscopic techniques are not widely available, and their use is limited to centers of excellence.

Citations

Citations to this article as recorded by

Exploring esophagogastric junction morphology and contractile integral: implications for refractory gastroesophageal reflux disease pathophysiology
Sihui Lin, Zhilong Chen, Wei Jiang, Yucheng Zhu
Scandinavian Journal of Gastroenterology.2025; 60(2): 130. CrossRef
Patients Presenting With Reflux Symptoms - Whom to Test and Whom to Treat?
Noy Lapidot Alon, Tomas Navarro Rodriguez, Ronnie Fass
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(1): 7. CrossRef
'Unmasking Endoscopic Patterns in PPI-Refractory GERD: Insights into Findings and Risk Factors'
A Samad
Endoscopy.2025; 57(S 02): S335. CrossRef
Potassium-competitive Acid Blockers for Treatment of Extraesophageal Symptoms and Signs
Gwang Ha Kim, Ronnie Fass
Journal of Neurogastroenterology and Motility.2025; 31(2): 170. CrossRef
ESÔFAGO DE BARRETT: UMA REVISÃO BIBLIOGRÁFICA
Marcelo Vinícius Pereira Silva, Elaine Timm, Allan Martins De Oliveira, Elizeu Augusto De Freitas Junior , Marlison Caldas Gonçalves Pereira
Brazilian Medical Students.2025;[Epub] CrossRef
Better diagnostic accuracy for GERD observed with the new MNBI cutoff: an observational study in Vietnam
Hang Dao Viet, Hue Luu Thi Minh, Long Hoang Bao, Phuong Do Nhat, Long Dao Van
BMC Gastroenterology.2025;[Epub] CrossRef
Long-term efficacy of endoscopic radiofrequency Stretta therapy for patients with refractory gastroesophageal reflux disease
Sung Eun Kim
Clinical Endoscopy.2024; 57(1): 48. CrossRef
Correlation of Endoscopic and Histopathological Diagnoses in Upper Gastrointestinal Tract Lesions: A Cross-Sectional Study
Sudhasmita Rauta, Pratima Baisakh, Aswini K Sahoo, Dhiren K Panda, Manas R Baisakh, Sushree s Dash
Cureus.2024;[Epub] CrossRef
The role of ghrelin and leptin in the formation of morphological changes esophagus of patients with gastro-esophageal reflux disease against type 2 diabetes
Olha Bondar-Keleberda
EUREKA: Health Sciences.2023; (4): 24. CrossRef

8,578 View
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Original Articles

Endoscopic radiofrequency Stretta therapy reduces proton pump inhibitor dependency and the need for anti-reflux surgery for refractory gastroesophageal reflux disease: Abraham Joel, Alakh Konjengbam, Yirupaiahgari Viswanath, Georgios Kourounis, Emily Hammond, Helen Frank, Shivani Kuttuva, Simon Mbarushimana, Hena Hidayat, Srivishnu Thulasiraman; Clin Endosc 2024;57(1):58-64. Published online May 2, 2023; DOI: https://doi.org/10.5946/ce.2023.026

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Background
/Aims: Radiofrequency treatment of the gastroesophageal junction using the Stretta procedure for treating gastroesophageal reflux disease (GERD) is observed to improve the symptoms and proton pump inhibitor (PPI) dependence and reduce the need for anti-reflux operations. As one of the largest studies in Europe, we evaluated the clinical outcomes of Stretta in patients with medically refractory GERD.
Methods
A tertiary UK center evaluated all patients with refractory GERD who underwent Stretta between 2014 and 2022. Patients and primary care professionals were contacted to obtain information regarding the initiation of PPI and reintervention after Stretta.
Results
Of the 195 patients (median age, 55 years; 116 women [59.5%]) who underwent Stretta, PPI-free period (PFP) data were available for 144 (73.8%) patients. Overall, 66 patients (45.8%) did not receive PPI after a median follow-up of 55 months. Six patients (3.1%) underwent further interventions. The median PFP after Stretta was 41 months. There was a significant negative correlation between PFP and age (p=0.007), with no differences between sexes (p=0.96). Patients younger than 55 years of age had a longer PFP than their older counterparts (p=0.005). Younger males had a significantly longer PFP than older males (p=0.021). However, this was not observed in the female cohort (p=0.09) or between the younger men and women (p=0.66).
Conclusions
Our findings suggest that Stretta is a safe and feasible option for treating refractory GERD, especially in younger patients. It prevents further anti-reflux interventions in most patients and increases the lead-time to surgery in patients with refractory GERD.

Citations

Citations to this article as recorded by

Efficacy of endoscopic radiofrequency ablation for proton pump inhibitor‐dependent gastroesophageal reflux disease: Multicenter prospective cohort study
Yuanxi Jiang, Zhiyu Dong, Ying Chen, Huihui Sun, Junwen Wang, Zhenxiang Wang, Qianqian Meng, Han Lin, Qingwei Zhang, Shengliang Chen, Zhizheng Ge, Luowei Wang, Shuchang Xu
Digestive Endoscopy.2025; 37(5): 501. CrossRef
Efficacy and safety of antireflux mucosectomy versus radiofrequency ablation of the lower esophageal sphincter for the treatment of GERD: a systematic review and meta-analysis
Cristian A. Angeramo, Mateo Lendoire, Fernando A.M. Herbella, Francisco Schlottmann
Gastrointestinal Endoscopy.2025; 102(1): 14. CrossRef
Redefining endoscopic management of refractory gastroesophageal reflux disease: the role of Stretta radiofrequency therapy and antireflux mucosectomy
Yuto Shimamura
Clinical Endoscopy.2025; 58(3): 398. CrossRef
Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa
Gwang Ha Kim
Clinical Endoscopy.2024; 57(1): 51. CrossRef
Long-term efficacy of endoscopic radiofrequency Stretta therapy for patients with refractory gastroesophageal reflux disease
Sung Eun Kim
Clinical Endoscopy.2024; 57(1): 48. CrossRef
Chronic cough and refractory chronic cough: An important distinction
Peter V. Dicpinigaitis
Journal of Precision Respiratory Medicine.2023; 6(1): 10. CrossRef

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6 Crossref

Safe implementation of transoral incisionless fundoplication as a new technique in a tertiary care center: Shivanand Bomman, Sofya Malashanka, Adil Ghafoor, David J. Sanders, Shayan Irani, Richard A. Kozarek, Andrew Ross, Michal Hubka, Rajesh Krishnamoorthi; Clin Endosc 2022;55(5):630-636. Published online August 17, 2022; DOI: https://doi.org/10.5946/ce.2022.003

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Background
/Aims: Transoral incisionless fundoplication (TIF) is an accepted anatomic treatment for gastroesophageal reflux disease in selected patients. In this report, we analyze our institution’s programmatic allocation of resources during the safe implementation of TIF as a new procedure.
Methods
A retrospective analysis of all patients who underwent TIF from January 2020 to February 2021 at our institution was performed. The process of initially allocating the operating room (OR) with overnight admission and postoperative esophagram for added safety, and subsequently transitioning TIF to the endoscopy suite (ES) as an outpatient procedure was described. Patient safety and outcomes were evaluated during transition.
Results
Thirty patients who underwent TIF were identified. The mean age was 51.2±16.0 years. TIF was performed in an OR in nine patients (30%) and 21 (70%) in the ES. All the OR patients were admitted overnight and had routine EG. In contrast, four (19%) from the ES group required clinically-indicated admission and three (14.2%) required esophagram. The mean procedure duration was significantly lower in the ES group (65.7 min vs. 84 min, p=0.02).
Conclusions
A stepwise, resource-efficient process was described that allowed safe initiation of TIF as a new technique and its effective transition to a fully outpatient procedure.

Citations

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Gastroesophageal reflux disease in children: What’s new right now?
Palittiya Sintusek, Mohamed Mutalib, Nikhil Thapar
World Journal of Gastrointestinal Endoscopy.2023; 15(3): 84. CrossRef
Assessing implementation strategy and learning curve for transoral incisionless fundoplication as a new technique
Muhammad Haseeb, Christopher C. Thompson
Clinical Endoscopy.2022; 55(6): 751. CrossRef

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125 Download
2 Web of Science
2 Crossref

Focused Review Series: Endoscopic Accessories Used for ESD

Endoscopic Accessories Used for More Advanced Endoluminal Therapeutic Procedures: Hyunsoo Chung; Clin Endosc 2017;50(3):234-241. Published online May 31, 2017; DOI: https://doi.org/10.5946/ce.2017.079

Abstract PDF PubReader ePub: Endoscopic accessories describe an extensive variety of auxiliary instruments used for diagnostic and therapeutic endoscopy. Various endoscopic accessories have been developed over the previous few decades and are mostly used for treating neoplastic lesions, such as early gastrointestinal (GI) carcinomas and premalignant lesions. Because of extensive research on natural orifice endoluminal surgery (NOTES) in the early 2000s and recent technological developments, new devices have been developed for various advanced endoluminal therapeutic procedures. In particular, a remarkable development of endoscopic management was achieved in the field of gastroesophageal reflux disease (GERD) and obesity. In both conditions, there is treatment gap between medical and surgical therapy. A large proportion of the patients who do not respond to medical treatment and lifestyle modification, still hesitate to directly undergo surgical treatment. To bridge this gap, endoscopic management has been receiving increasing attention. In this article, I review endoscopic and/or endoluminal devices used for the treatment of GERD and obesity with proposed mechanisms of their function.

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Reviews

Endoscopic Management of Gastroesophageal Reflux Disease: Revisited: Zaheer Nabi, D. Nageshwar Reddy; Clin Endosc 2016;49(5):408-416. Published online September 30, 2016; DOI: https://doi.org/10.5946/ce.2016.133

Abstract PDF PubReader ePub

Gastroesophageal reflux disease (GERD) is defined by the presence of troublesome symptoms resulting from the reflux of gastric contents. The prevalence of GERD is increasing globally. An incompetent lower esophageal sphincter underlies the pathogenesis of GERD. Proton pump inhibitors (PPIs) form the core of GERD management. However, a substantial number of patients do not respond well to PPIs. The next option is anti-reflux surgery, which is efficacious, but it has its own limitations, such as gas bloating, inability to belch or vomit, and dysphagia. Laparoscopic placement of magnetic augmentation device is emerging as a useful alternative to conventional anti-reflux surgery. However, invasiveness of a surgical procedure remains a concern for the patients. The proportion of PPI non-responders or partial responders who do not wish for anti-reflux surgery defines the ‘treatment gap’ and needs to be addressed. The last decade has witnessed the fall and rise of many endoscopic devices for GERD. Major endoscopic strategies include radiofrequency ablation and endoscopic fundoplication devices. Current endoscopic devices score high on subjective improvement, but have been unimpressive in objective improvement like esophageal acid exposure. In this review, we discuss the current endoscopic anti-reflux therapies and available evidence for their role in the management of GERD.

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Transoral Incisionless Fundoplication for Refractory Gastroesophageal Reflux Disease: Where Do We Stand?: Deepanshu Jain, Shashideep Singhal; Clin Endosc 2016;49(2):147-156. Published online February 15, 2016; DOI: https://doi.org/10.5946/ce.2015.044

Abstract PDF PubReader ePub

Gastroesophageal reflux disease (GERD) is a chronic, progressive, and costly medical condition affecting a substantial proportion of the world population, predominantly the Western population. The available treatment options for patients with refractory GERD symptoms are limited to either laparoscopic surgery with significant sequelae or potentially lifelong, high-dose proton pump inhibitor therapy. The restoration of the antireflux competence of the gastroesophageal junction at the anatomic and physiologic levels is critical for the effective long-term treatment of GERD. Transoral incisionless fundoplication (TIF) surgery is a safe, well-tolerated, and effective treatment that has yielded significant symptomatic improvement in patients with medically refractory GERD symptoms. In this review article, we have summarized case series and reports describing the role of TIF for patients with gastroesophageal reflux symptoms. The reported indications, techniques, complications, and success rates are also discussed.

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Alyssa Y. Choi, Mary Kathryn Roccato, Jason B. Samarasena, Jennifer M. Kolb, David P. Lee, Robert H. Lee, Shaun Daly, Marcelo W. Hinojosa, Brian R. Smith, Ninh T. Nguyen, Kenneth J. Chang
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Case Reports

Esophgeal Perforation and Bilateral Empyema Following Endoscopic EsophyX Transoral Incisionless Fundoplication: Hawa Edriss, Amal El-Bakush, Kenneth Nugent; Clin Endosc 2014;47(6):560-563. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.560

Abstract PDF PubReader ePub

Transoral incisionless fundoplication (TIF) has been used for endoscopic treatment of gastroesophageal reflux disease (GERD). TIF using the EsophyX device system (EndoGastric Solutions) was designed to create a full-thickness valve at the gastroesophageal junction through the insertion of multiple fasteners; it improves GERD, reduces proton pump inhibitor use, and improves quality of life. Although TIF is effective in select patients, a significant subset of patients undergoing TIF develop persistent or recurrent GERD symptoms and may need antireflux surgery to control the GERD symptoms. We now report a 48-year-old man with chronic GERD unresponsive to medical management. He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure. He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas. Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up.

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A comparative analysis of ARMS (anti-reflux mucosectomy) and TIF (transoral incisionless fundoplication) in the treatment of gastroesophageal reflux disease (GERD)
Anmol Mohan, Faryal Sohail, Namra Asif Saeed, Maryam Jameel, Mazen W. Assal, Zim Warda Hasan, Arfah Zafar, Hasibullah Aminpoor, Vikash Kumar
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Efficacy and patient satisfaction of single-session transoral incisionless fundoplication and laparoscopic hernia repair
Catherine Gisi, Kelly Wang, Farhaad Khan, Sonya Reicher, Linda Hou, Clark Fuller, James Sattler, Viktor Eysselein
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Long-term Outcomes of Patients Receiving a Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux
Robert A. Ganz, Steven A. Edmundowicz, Paul A. Taiganides, John C. Lipham, C. Daniel Smith, Kenneth R. DeVault, Santiago Horgan, Garth Jacobsen, James D. Luketich, Christopher C. Smith, Steven C. Schlack-Haerer, Shanu N. Kothari, Christy M. Dunst, Thomas
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4 Web of Science
4 Crossref

A Case of Postfundoplication Dysphagia without Symptomatic Improvement after Endoscopic Dilatation: Chanhee Kyung, Han Ho Jeon, Heewook Kim, Jie-Hyun Kim, Young Hoon Youn, Hyojin Park; Clin Endosc 2014;47(1):104-107. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.104

Abstract PDF PubReader ePub: Laparoscopic fundoplication is a treatment option for gastroesophageal reflux disease refractory to medical treatment. When deciding whether or not to undergo surgery, patients with refractory gastroesophageal reflux disease and esophageal motility disorder need to fully understand the operative procedure, postoperative complications, and residual symptoms such as dysphagia, globus sensation, and recurrence of reflux. Herein, we report a case of a patient diagnosed with gastroesophageal reflux disease and aperistalsis who underwent Nissen (total, 360°) fundoplication after lack of response to medical treatment and subsequently underwent pneumatic dilatation due to unrelieved postoperative dysphagia and globus sensation.

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Review

Endoscopic Treatment of Refractory Gastroesohageal Reflux Disease: Won Hee Kim, Pil Won Park, Ki Baik Hahm, Sung Pyo Hong; Clin Endosc 2013;46(3):230-234. Published online May 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.3.230

Abstract PDF PubReader ePub

Though efficient acid suppression with proton pump inhibitors (PPIs) remains the mainstay of treatment of gastroesophageal reflux disease (GERD), some of the patients showed refractory response to PPIs, necessitating further intervention. After increasing dose of PPIs and other kinds of pharmacological intervention adopting prokinetics or others, variable endoscopic treatments are introduced for the treatment of these refractory cases. The detailed introduction regarding endoscopic treatment for GERD is forwarded in this review article. Implantation of reabsorbable or synthetic materials in the distal esophagus was tried in vain and is expelled from the market due to limited efficacy and serious complication. Radiofrequency energy delivery (Stretta) and transoral incisionless fundoplication (EsophyX) are actively tried currently.

Citations

Citations to this article as recorded by

Endoskopische und operative Therapie der gastroösophagealen Refluxkrankheit
Sebastian F. Schoppmann, Gerd Jomrich
Die Gastroenterologie.2024; 19(6): 524. CrossRef
Refractory gastroesophageal reflux disease
C. R. Subramanian, G. Triadafilopoulos
Gastroenterology Report.2015; 3(1): 41. CrossRef
Long-term outcomes of patients with refractory gastroesophageal reflux disease following a minimally invasive endoscopic procedure: a prospective observational study
Wei-Tao Liang, Zhong-Gao Wang, Feng Wang, Yue Yang, Zhi-Wei Hu, Jian-Jun Liu, Guang-Chang Zhu, Chao Zhang, Ji-Min Wu
BMC Gastroenterology.2014;[Epub] CrossRef

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Original Article

Efficacy of I-scan Endoscopy in the Diagnosis of Gastroesophageal Reflux Disease with Minimal Change: Min Sik Kim, Seok Reyol Choi, Myung Hwan Roh, Jong Hun Lee, Jin Seok Jang, Byung Geun Kim, Sang Ock Kim, Ji Sun Han, Chien Ter Hsing; Clin Endosc 2011;44(1):27-32. Published online September 30, 2011; DOI: https://doi.org/10.5946/ce.2011.44.1.27

Abstract PDF PubReader ePub

Background/Aims

The aim of the study was to evaluate the efficacy of i-scans for the diagnosis of gastroesophageal reflux disease, especially where only minimal change is involved.

Methods

The esophageal mucosa was inspected using an i-scan following conventional white light endoscopy. The examination with iscan was performed under tone enhancement (TE) esophagus (e) mode. Patients with subtle distal esophageal mucosal changes without definite mucosal breaks, such as blurring of Z-line (B), mucosal coarseness (C), hyperemic or purplish discoloration (D), erythema (E), ectopic gastric mucosal islet (I) and mixed type were classified as minimal change.

Results

A total of 156 patients were included. Using i-scan endoscopy, the number of minimal change was found to further increase from 94 (conventional endoscopy; 19B, 9C, 29D, 13E, 5I, 19 mixed type) to 109 (i-scan; 15B, 8C, 29D, 16E, 5I, 36 mixed type). And 14 patients who had single type by conventional endoscopy were converted to mixed type after i-scan. Therefore, 29 of 156 patients were upgraded after i-scan, they were account for 19% (p<0.0001; 95% confidence interval, 0.13 to 0.25).

Conclusions

The use of i-scan endoscopy significantly improves the identification of minimal change and helps to identify more precisely the type of minimal change.

Citations

Citations to this article as recorded by

Reflux Finding Score Using HD Video Chromoendoscopy: A Diagnostic Adjunct in Suspected Laryngopharyngeal Reflux?
Nurhamizah Mahmud Mohayuddin, Mawaddah Azman, Aneeza Khairiyah Wan Hamizan, Farah Dayana Zahedi, Thomas Leigh Carroll, Marina Mat Baki
Journal of Voice.2024; 38(6): 1439. CrossRef
Endoscopic Advances in the Diagnosis and Management of Gastroesophageal Reflux Disease
Priyadarshini Loganathan, Mahesh Gajendran, Abhilash Perisetti, Hemant Goyal, Rupinder Mann, Randy Wright, Shreyas Saligram, Nirav Thosani, Chandraprakash Umapathy
Medicina.2024; 60(7): 1120. CrossRef
Usefulness of Endoscopy for the Detection and Diagnosis of Primary Esophageal Motility Disorders and Diseases Relating to Abnormal Esophageal Motility
Shiko Kuribayashi, Hiroko Hosaka, Toshio Uraoka
Diagnostics.2023; 13(4): 695. CrossRef
Role of endoscopy in gastroesophageal reflux disease
Daniel Martin Simadibrata, Elvira Lesmana, Ronnie Fass
Clinical Endoscopy.2023; 56(6): 681. CrossRef
The role of endoscopy in the management of gastroesophageal reflux disease
Shiko Kuribayashi, Hiroko Hosaka, Fumihiko Nakamura, Ko Nakata, Keigo Sato, Yuki Itoi, Yu Hashimoto, Kengo Kasuga, Hirohito Tanaka, Toshio Uraoka
DEN Open.2022;[Epub] CrossRef
Evaluation of Minimal Change Lesions Using Linked Color Imaging in Patients With Nonerosive Reflux Esophagitis
Ni-Na Zhang, Yi-Min Ma, Qi Sun, Liang-Liang Shi, Yin Xie, Xiao-Ping Zou
Journal of Clinical Gastroenterology.2022; 56(5): 405. CrossRef
Narrowed-spectrum Technologies in Endoscopic Imaging of The Upper Gastrointestinal Tract
Amrit K. Kamboj, Allon Kahn, Cadman L. Leggett
Techniques and Innovations in Gastrointestinal Endoscopy.2021; 23(1): 19. CrossRef
Image-enhanced endoscopy is specific for the diagnosis of non-erosive gastroesophageal reflux disease
Neil D. Parikh, Artur V. Viana, Saloni Shah, Loren Laine
Scandinavian Journal of Gastroenterology.2018; 53(3): 260. CrossRef
Ambulatory 24-hour multichannel intraluminal impedance-pH monitoring and high resolution endoscopy distinguish patients with non-erosive reflux disease from those with functional heartburn
Chuanlian Chu, Quanlin Du, Changqing Li, Linlu Zhang, Xiaoyan Zhou, Fang Zuo, Yanmin Zhang, Fang Li, Guofeng Xie, Yanqing Li, John Green
PLOS ONE.2017; 12(4): e0175263. CrossRef
High-definition endoscopy withiScan and Lugol's solution for the detection of inflammation in patients with nonerosive reflux disease: histologic evaluation in comparison with a control group
J. W. Rey, N. Deris, J. U. Marquardt, T. Thomaidis, M. Moehler, J. M. Kittner, M. Nguyen-Tat, S. Dümcke, A. Tresch, S. Biesterfeld, M. Goetz, J. Mudter, M. F. Neurath, P. R. Galle, R. Kiesslich, A. Hoffman
Diseases of the Esophagus.2016; 29(2): 185. CrossRef
Identifying Minimal Changes in Nonerosive Reflux Disease
Scott L. Gabbard, Ronnie Fass, Carla Maradey-Romero, Rachel Gingold Belfer, Ram Dickman
Journal of Clinical Gastroenterology.2016; 50(1): 11. CrossRef
Minimal Change Esophagitis
Han Seung Ryu, Suck Chei Choi
The Korean Journal of Gastroenterology.2016; 67(1): 4. CrossRef
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Association between Gastroesophageal Flap Valve and Gastroesophageal Reflux: Kyung Yup Kim, M.D., Kee Tae Park, M.D., Tae Oh Kim, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.; Korean J Gastrointest Endosc 2007;34(1):1-8. Published online January 30, 2007

Abstract PDF: Background
/Aims: Endoscopic grading of the gastroesophageal flap valve (GEFV) was suggested to be a good predictor of the gastroesophageal reflux status. The aim of this study was to examine the association between the GEFV and gastroesophageal reflux. Methods: A total of 599 patients (245 men and 354 women; mean age 51.0⁑0.5 years) who underwent endoscopy, esophageal manometry, and ambulatory pH monitoring were included. GEFV was graded I through to IV using Hill's classification. The GEFV was classified into main 2 groups: the normal GEFV (grade I and II) and the abnormal GEFV groups (grade III and IV). The findings of endoscopy, esophageal manometry, and ambulatory pH monitoring were compared. Results: An increased GEFV grade was significantly associated with reflux esophagitis and Barrett's epithelium (p＜0.001). The LES pressure was significantly lower in the abnormal GEFV group (p＜0.001). All variables showing gastroesophageal reflux in the probe were significantly higher in the abnormal GEFV group (p＜0.001). The frequency of gastroesophageal reflux disease (GERD) was higher in the abnormal GEFV group (p＜0.001). Conclusions: There is an association between the altered geometry of the GEFV and the presence of GERD. The endoscopic grading of the GEFV is easy and provides useful information on the gastroesophageal reflux status.

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Interobserver Variation in the Endoscopic Diagnosis of Gastroesophageal Reflux Disease: Jun Haeng Lee, M.D., Jong-Soo Lee, M.D., Poong-Lyul Rhee, M.D., Hoon Jai Chun, M.D.*, Myung-Gyu Choi, M.D.^†, Young-Tae Bak, M.D.*, Dongkee Kim, M.D.^‡, Kijun Song, M.D.^‡ and Sang In Lee, M.D.^§; Korean J Gastrointest Endosc 2006;33(4):197-203. Published online October 30, 2006

Abstract PDF: Background
/Aims: A diagnosis of gastroesophageal reflux disease (GERD) is based on the typical symptoms, such as acid regurgitation and heartburn. However, there is a very high inter-observer variation in the evaluation of GERD patients. Methods: The endoscopic images of forty-two cases with reflux symptoms (2 still images and 15-second video images per case) were analyzed by 18 experienced endoscopists and 22 trainees. The findings were classified into the following: (1) 6 groups (modified LA classification: 4 LA groups, minimal, and normal), (2) erosinve and non-erosive, and (3) confluent erosive and others. The level of inter-observer variation is expressed as a kappa value. Results: The level of inter-observer agreement of the 18 experienced endoscopists for classifying the patients into 6 groups was fairly low (kappa=0.364). However, when the findings were classified into the 2 groups suggested in the Genval workshop (NERD, A, or B versus C or D), the level of inter- observer agreement increased substantially (kappa=0.710). The kappa value of the 22 trainees for classifying the patients into 6 groups was 0.402. Conclusions: Modified LA classification with minimal change lesions showed a fairly low level of agreement. The problem caused by inter-observer variations decreased significantly when the findings were classified into two groups. (Korean J Gastrointest Endosc 2006;33:197⁣203)

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Three Cases of Gastroesophageal Reflux Disease Treated by Laparoscopic Fundoplication: Dae Hoon Song, M.D., Hyojin Park, M.D., Jina Park, M.D., Sang Won Ji, M.D., Dong Sup Yoon, M.D.* and Sang In Lee, M.D.; Korean J Gastrointest Endosc 2005;30(1):28-34. Published online January 30, 2005

Abstract PDF: Medical treatment so far takes the major portion in the treatment of gastroesophageal reflux disease (GERD). Histamine-2 receptor antagonists, proton pump inhibitors and antacids, which are used in the medical treatment of GERD, decreases intragastric acidity, and therefore decreases acid reflux. However, recurrences are frequently observed after the cessation of medication. On the other hand, fundoplication, the surgical management of GERD, aims for physiologic reconstruction of esophagogastric junction, and for correcting the pathogenetic cause of GERD. But fundoplication is linked to risks related to surgery and general anesthesia. Laparoscopic funcoplication minimizes these risks. We recently experienced three cases of GERD improved by laparoscopic 270^o fundoplication. One patient was intolerant of long-term proton pump inhibitor treatment, and two patients had hiatal hernia, and one of them showed failure to medical treatment. This report describes these three cases with a brief review of literatures survey. (Korean J Gastrointest Endosc 2005;30:28⁣34)

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경미한 미란성 식도염에서 식도 운동 및 위산 역류의 양상 ( Patterns of Gastroesophageal Reflux and Esophageal Motility in Patients with Mild Reflux Esophagitis ): Korean J Gastrointest Endosc 1999;19(5):693-699. Published online November 30, 1998

Abstract PDF: Background
/Aims: The major complications of reflux esophagitis are stricture formation and Barrett's esophagus. In Korea, the incidence of these complications is low and most patients with reflux esophagitis undergo a mild clinical course. The purpose of this study was to investigate patterns of acid reflux and esophageal motility in mild reflux esophagitis in Korea. Methods: Using conventional manometry and 24-hour ambulatory pH monitoring, we were investigated esophageal motility and patterns of gastroesophageal reflux in 41 patients with reflux esophagitis Savary-Miller (S-M) Ib using on endoscopy. The total supine, and upright reflux periods, as well as frequency and duration of reflux episodes were determined from the 24-hour pH monitoring record using standard software. Pathologic reflux was defined when the percentage of the total time with pH less than 4 (acid exposure time) exceeded 4%. Results: Pathologic reflux was observed in 17 patients (41.5%), who were categorized into upright refluxers (70.6%), supine refluxers (11.8%), and combined refluxers (17.6%). Patients with reflux esophagitis did not differ in lower esophageal sphincter pressure from the normal subjects. There were two patients (4.9%) with a lower esophageal pressure ≤ 10 mmHg and four patients (9.8%) with hiatal hernia. Failed peristalsis was seen in 4 patients (9.8%). Conclusions: A high proportion of upright reflux and low incidence of esophageal peristaltic dysfunction may contribute to the low incidence of stricture formation and Barrett's esophagus in patients with mild reflux esophagitis in Korea. (Korean J Gastrointest Endosc 19: 693∼699, 1999)

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원저 : 위식도 역류질환에서 식도염의 발현율 ( Original Articles : Incidence of Esophagitis in Gastroesophageal Reflux Disease ( GERD ) ): Korean J Gastrointest Endosc 1994;14(2):145-150. Published online November 30, 1993

Abstract PDF: The exact incidence of esophagitis in gastroesophageal reflux disease (GERD) remains poorly understood in Korea. To determine incidence of esophagitis in GERD, from August 1988 to July 1993, endoscopy, esophageal manometry with Bernstein test, and ambulatory 24 hour esophageal pH monitoring were carried out in a group of 349 patients with symptoms of heartburn or noncardiac chest pain. Based on these studies, 151(40%) patients had some degree of GERD and pstients were categorized as having: pathologic reflux, 98 patients; symptomatic reflux, 42 patients; and sensitive mucosal reflux, 11 patients. Among 151 patients with GERD, 27 patients(18%) had some degree of esophagitis. In conclusion, 40% of patients with symptoms suggestive of GERD have GERD. GERD is divided into subgroups; pathologic reflux, symptomatic reflux, and mucosal sensitive reflux. Less than 20% of GERD have esophagitis or esophageal mucosal injury and these low incidence of mucosal injury in Korean may be due to increased esophageal mucosal resistance.

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