Endoscopic Mucosal Techniques for GERD: Dawn of New Era in Endoscopic GERD Management

Abstract Gastroesophageal reflux disease is commonly managed with proton pump inhibitors (PPIs) or antireflux surgery (e.g., fundoplication). However, a subset of patients remains PPI-refractory or PPI-dependent, prompting the development of less invasive endoscopic therapies. In the last decade, several endoscopic mucosal-directed techniques have emerged to augment the gastroesophageal junction barrier by inducing mucosal remodeling. These include antireflux mucosectomy, antireflux mucosal ablation, antireflux mucosal valvuloplasty, and antireflux mucoplasty with flap valve formation. Each technique involves altering the distal esophageal or gastric cardia mucosa to enhance the reflux barrier, but they differ in approach (resection, ablation, or creation of a flap valve) and clinical experience. This narrative review describes each procedure and summarizes human clinical data focusing on symptom relief, esophageal acid exposure, durability of effect, and safety.