State of evidence and future perspectives in minimally invasive management of gastroesophageal reflux disease (GERD)

The future of minimally invasive treatment gastroesophageal reflux disease (GERD) will be realized through collaborative precision medicine more than any foreseeable new technology. Multidisciplinary foregut societies are fostering the collaboration and expertise needed to provide a personalized GERD. Patient-centric therapy consider combination therapies’ clinical successes. Taking patient uncontrolled on medication controlled via procedure replace historical mutual exclusivity acid-suppressive or surgery as for Research directed at focus subgroup analysis rather randomized trials. Recognition crural diaphragm barrier which fails in GERD patients regardless presence an axial hernia has resulted from modalities such 3-D high-resolution impedance manometry, endoscopic ultrasound, functional luminal planimetry. More precise selection purely therapies possible.The concept reduction replaced by calibration repair restore its sphincteric function. Partnering surgically calibrated partnered with interventional gastrointestinal reinforcement lower esophageal sphincter foster physician alliances offer patient-centric alternatives traditional fundoplication. As such, laparoscopic Nissen Fundoplication lose primacy relegated most severe Magnetic augmentation (LINX®), varing degrees partial fundoplication, endoluminal without hiatal become mainstay AntiReflux Procedures. Radio Frequency modulation (Stretta®) may alternative neuromodulators treating acid-sensitive esophagus. nascent era robotics improve precision, reproducibility revive natural orifice transluminal surgery.