The Role of Endoscopy in Gastroesophageal Reflux Disease

Background: Gastroesophageal reflux disease (GERD) is a common and heterogeneous condition that has traditionally been assessed using endoscopy for visual identification of mucosal injury. In recent years, advances in endoscopic technology have significantly reshaped both the diagnostic and therapeutic approaches to GERD. Summary: Modern imaging modalities, such as high-resolution and image-enhanced endoscopy, now allow for the detection of subtle mucosal changes. Functional endoscopic techniques, including the Endoscopic Pressure Study Integrated System (EPSIS), enable real-time physiological assessment of esophageal function and contribute to a better understanding of GERD pathophysiology. On the therapeutic front, endoscopy has emerged as a viable, minimally invasive alternative to surgery in managing refractory or proton pump inhibitor (PPI)-dependent GERD. Techniques such as anti-reflux mucosectomy, anti-reflux mucosal ablation (ARMA), and endoscopic submucosal dissection for GERD are increasingly recognized for their safety and efficacy. Key Messages: (a) Modern endoscopic techniques improve the detection of subtle mucosal and functional abnormalities in GERD. (b)Functional endoscopy techniques offer insights into the mechanisms of GERD symptoms and lower esophageal sphincter dysfunction. (c) Endoscopic therapies are minimally invasive treatment options for patients with PPI-refractory or PPI-dependent GERD. (d) Endoscopy is expected to play a central role in the comprehensive management of GERD.