Endoscopic Management of Gastroesophageal Reflux Disease: An Indian Perspective

Abstract

Gastroesophageal reflux disease (GERD) is a common chronic gastrointestinal disorder in India, with rising prevalence due to lifestyle changes, urbanization, and improved diagnosis. Proton pump inhibitors remain first-line therapy; however, many patients experience persistent symptoms, require long-term medication, or seek alternatives to chronic pharmacotherapy. Although laparoscopic fundoplication is an effective definitive treatment, its invasive nature limits widespread acceptance.

Endoscopic therapies have emerged as minimally invasive options bridging the gap between medical and surgical management. This review summarizes established and emerging endoscopic interventions for GERD, including radiofrequency therapy, endoscopic fundoplication devices, and mucosal resection or ablation techniques. Among these, antireflux mucosectomy (ARMA) and related mucosal remodeling strategies have gained attention for inducing scar-mediated tightening of the gastroesophageal junction.

Recent innovations include hybrid approaches combining mucosal ablation with endoscopic plication to enhance the antireflux barrier. Techniques such as ARMA with mucoplasty and valve, GERDx with argon plasma coagulation (APC), GERDx with ARMA, and endosuturing combined with ARMA represent evolving strategies for improving procedural durability.

Special emphasis is placed on APC combined with GERDx, an approach refined in the Indian setting that integrates mucosal remodeling with endoscopic suturing to strengthen the antireflux barrier. This review discusses mechanisms, patient selection, clinical outcomes, and safety considerations, highlighting the relevance of these techniques in resource-variable healthcare environments and emphasizing the need for standardized protocols and long-term outcome data.