The basic principle of antireflux procedures employing endoscopic intervention aims to create a mechanical barrier to prevent primary pathophysiology in gastroesophageal reflux disease (GERD). We review, highlight, and discuss the past and present status of endoluminal therapy. Currently, there are 3 commonly employed anti-reflux endoluminal procedures: fundoplication or suturing techniques (EndoCinch, NDO, and EsophyX), intramural injection or implant techniques (enhancing lower esophageal sphincter (LES) volume and/or strengthening compliance of the LES-Enteryx and Gatekeeper), and radiofrequency ablation of LES and cardia. EndoCinch plication requires further study and modification of technique before it can be recommended because of durability issues. Esophynx, the transoral incisionless fundoplication, may reduce hiatal hernias and increase LES length. Preliminary studies have shown promising reduction in symptoms and medication use but evidence concerning safety and long-term durability is still pending. The safety issue with injection technique is the main concern as evident from the incidences of implant withdrawals after reported major adverse events. Future research with cautious monitoring is required before any new implant material can be recommended for commercial application. Radiofrequency ablation therapy is regaining popularity in treating refractory symptoms despite PPI use due to improved efficacy, durability, and safety after years of refinement of protocol. 1. Introduction Gastroesophageal reflux disease (GERD) is a disease spectrum caused by regurgitation of stomach contents causing troublesome esophageal or extraesophageal symptoms as defined by Montreal definitions [1]. Either mild heartburn and/or regurgitation for at least 2 days per week or moderate to severe symptoms for at least one day per week qualifies as significant symptom-based diagnosis [2]. Phenotypical classifications of GERD are nonerosive reflux disease (NERD), erosive esophagitis (EE), and Barrett’s esophagus (BE). Population-based study reported 15%–20% of the Western population experience reflux on a weekly basis which can lead to impoverishment of a country’s economy and quality of life [3]. Dent et al. reported the prevalence of GERD in Sweden (15.5%), Italy (11.8%), China, Japan, Korea (3.4%–8.5%), and Taiwan (9%–24.6%), respectively [4]. Subanalysis shows that EE and hiatus hernia are more common in Europe than in Asia with the exception of Taiwan which reported similar EE prevalence as Europe. Over years, the prevalence of GERD is increasing by
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