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Definition
Symbol
High quality
4444
Moderate
quality
444B
Low quality
44BB
Very low
quality
4BBB
esophagus and appears to reduce GERD by decreasing tissue compliance and reducing transient lower esophageal
relaxations.54 A recent meta-analysis of 18 studies involving
1441 patients found signicant improvement in heartburn
and GERD quality of life scores after the Stretta procedure.56 However, although the esophageal acid exposure,
as measured by the DeMeester score, was signicantly
reduced after treatment (44.4 vs 28.5, P Z .007), it did
not normalize. In addition, no signicant increase in
lower esophageal sphincter pressure was observed.
Adverse events were infrequent and typically minor. The
technique appears to durably relieve GERD symptoms
for up to 10 years in the majority of patients.57,58
The TIF procedure received U.S. Food and Drug Administration approval in 2007 and has undergone several device and technique modications since the initial
approval.54 Most studies involving TIF have been small
with short-term follow-up. The results have been variable,
with poorer results observed with earlier versions of the
device/technique. A systematic review of TIF that included
15 studies and 550 procedures found improved GERD
health-related quality of life scores (21.9 vs 5.9, P !
.0001) after the procedure.59 PPI use was discontinued in
67% of patients. Limitations of the analysis of these
studies include a lack of routine reporting of pH data
and a mean follow-up period of only 8.3 months. Major
adverse events were reported in 3.2% of patients. Most
recently, 3 randomized trials with at least 6-month followup found that TIF was more effective than high-dose PPI
therapy in eliminating troublesome regurgitation or extraesophageal symptoms of GERD.60-62
Endoluminal antireux techniques represent potentially
new therapeutic indications for GI endoscopy. Prospective
trials comparing these therapies with existing medical and
surgical options by using objective measures of GERD as
the primary endpoint could be useful in further dening
the clinical role of these procedures. Appropriate patient
selection and endoscopist experience and training should
be carefully considered before pursuing these therapies.
Volume 81, No. 6 : 2015 GASTROINTESTINAL ENDOSCOPY 1307
Savary-Miller
Grade
Description
One (or more) mucosal break no longer than 5 mm that does not extend between the tops of 2 mucosal folds
One (or more) mucosal break O5 mm that does not extend between the tops of 2 mucosal folds
One (or more) mucosal break that is continuous between the tops of R2 mucosal folds but that involves !75%
of the circumference
One (or more) mucosal break that involves at least 75% of the esophageal circumference
Barretts esophagus with histologically confirmed intestinal differentiation within the columnar epithelium.
SUMMARY
We recommend that uncomplicated GERD be diagnosed on the basis of typical symptoms without the
use of diagnostic testing, including EGD. 4444
We recommend EGD for patients who have symptoms
suggesting complicated GERD or alarm symptoms.
444B
4BBB
4444
DISCLOSURE
Dr Khashab is a consultant for and member of the
advisory board of Boston Scientic, is a consultant for
Olympus American, and has received research support
from Cook Medical. Dr Chathadi is a consultant for Boston Scientic. Dr Muthusamy is a consultant for and has
received honoraria and research support from Covidien
GI Solutions. Dr Fanelli is a consultant for EndoGastric
Solutions, has received royalties for unrelated inventions
and product development from Cook Surgical Inc, and
has minor ownership interest in Allurion Technologies
Inc and Mozaic Medical Inc. All other authors disclosed
no nancial relationships relevant to this article.
Abbreviations: BE, Barretts esophagus; PPI, proton pump inhibitor; TIF,
transoral incisionless fundoplication.
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Prepared by:
ASGE STANDARDS OF PRACTICE COMMITTEE
V. Raman Muthusamy, MD, FASGE
Jenifer R. Lightdale, MD, MPH, NAPSGHAN Representative
Ruben D. Acosta, MD
Vinay Chandrasekhara, MD
Krishnavel V. Chathadi, MD
Mohamad A. Eloubeidi, MD, MHS, FASGE
Robert D. Fanelli, MD, FACS, FASGE, SAGES Representative
Lisa Fonkalsrud, BSN, RN, CGRN, SGNA Representative
Ashley L. Faulx, MD, FASGE
Mouen A. Khashab, MD
John R. Saltzman, MD, FASGE
Aasma Shaukat, MD, MPH, FASGE
Amy Wang, MD
Brooks Cash, MD, FASGE, previous committee Chair
John M. DeWitt, MD, Chair
This document was developed by the ASGE Standards of Practice
Committee. This document was reviewed and approved by the Governing
Board of the American Society for Gastrointestinal Endoscopy.