Gastroesophageal reflux disease is one of the leading gastrointestinal disorders. Current treatments include lifestyle modifications, pharmacological therapies, surgical fundoplications, and, more recently, endoscopic procedures. The rising concern of long-term side effects of the popular proton-pump inhibitors and the more recent evidence raising doubts about the durability of fundoplication have spurred reinterest in endoscopic procedures to treat reflux disorders. In the aftermath of several innovative antireflux procedures that were introduced and failed clinically or financially over the past decade, there is lingering confusion regarding the merits of the presently available interventions. This paper focuses on one endoscopic procedure, Stretta, which now enjoys the longest experience, a recent meta-analysis, and robust data supporting its safety, efficacy, and durability. Stretta reduces esophageal acid exposure, decreases the frequency of transient lower esophageal relaxation, increases patient satisfaction, decreases medication use, and improves quality of life. As such, this procedure remains a valuable nonsurgical treatment option in the management of gastroesophageal reflux disease. 1. The Burden of Gastroesophageal Reflux Disease Gastroesophageal reflux disease (GERD) is the most common digestive disorder affecting one third of the population worldwide and resulting in 4 to 5 million physician visits annually. It results primarily from the loss of an effective antireflux barrier against the retrograde movement of gastric contents into the distal esophagus. The average incremental cost in the United States to an employer for an employee with GERD in 2007 was estimated to be $ 3,355 per year including medical costs, prescription drug costs, and indirect costs such as absenteeism and disability [1]. Furthermore, a significant financial burden on medical care comes from hospital admissions due to acid-induced noncardiac chest pain. Uncontrolled GERD results in a significant reduction in quality and productivity at work. GERD is also a risk factor for esophageal adenocarcinoma that is becoming increasingly prevalent and has the fastest rising incidence of any cancer [2]. The current treatment for GERD consists of lifestyle modifications, pharmacological therapies, endoscopic procedures, and surgical interventions. The initial management of GERD includes lifestyle modifications, such as elevating the head of the bed, dietary modifications, restricting alcohol, and managing obesity. Pharmacological management typically consists of the use of H2
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