Endoscopic Management of Gastroesophageal Reflux Disease: Revisited (original) (raw)

Fig. 1. Currently available endoscopic anti-reflux modalities. Stretta (Mederi Therapeutics), EsophyX (EndoGastric Solutions), MUSE (Medigus), GERDx (G-SURG GmbH).

Fig. 2. (A) Radiofrequency device (Stretta; Mederi Therapeutics) with a four-needle balloon catheter system. (B) Depiction of Stretta procedure-radiofrequency energy delivered to gastroesophageal junction muscle at multiple sites.

Fig. 3. (A) Transoral fundoplication device (EsophyX; EndoGastric Solutions) and its components. (B) Retroflexed device in the stomach. (C) Engaging the helical retractor into the tissue. (D) Application of H-shaped polypropylene fasteners (about 20). (E) Creation of full-thickness partial circumference fundoplication.

Fig. 4. MUSE (Medigus) endoscopic stapling device and its components.

Fig. 5. (A, B) Full thickness endoscopic plication device (GERDx; G-SURG GmbH). (C) GERDx inside the stomach in retroflexed view. (D) Advancement of ‘Drill helix’ into gastric cardia. (E) Closure of the device arms after gathering tissue and deployment of suture. (F) Reopening of the device arms after plication implant.

Fig. 6. (A) Submucosal injection of saline with indigo-carmine at gastric cardia. (B) Application of snare over the mucosa with cap-endoscopic mucosal resection technique. (C) Completion of near circumferential (2/3) resection of gastric mucosa. (D) Actively bleeding spurter during mucosectomy procedure. (E) Effective control of bleeding vessel with coagrasper.