Endoscopic antireflux procedures

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Abstract
Laparoscopic fundoplication is often proposed as an alternative and more definitive option, especially in young patients, because it is intended to cure the disorder and the laparoscopic approach makes surgery more acceptable.7, 8 Despite the high success rate of surgery in resolving typical reflux symptoms, substantial morbidity and some mortality exist. Complications such as dysphagia, inability to belch, diarrhoea, and flatulence may develop in up to 30% of patients.9 Recent publications tempered the enthusiasm for antireflux surgery. Spechler et al reported that 62% of patients who underwent open antireflux surgery as part of a controlled study were still taking acid suppressive drug after 10 years.10 Similar data were reported in patients who underwent this procedure in routine clinical practice. Medical therapy was required for control of heartburn in approximately one third of patients after laparoscopic fundoplication and new onset of symptoms was common after surgery.11 Thus in spite of well established short term efficacy, surgery is not an ideal solution.