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Lianyong Li
Xinke Sui
Qiang Cai
Editors
Endoscopic Therapy
for Gastroesophageal
Reflux Disease
Endoscopic Therapy for Gastroesophageal
Reux Disease
Lianyong Li • Xinke Sui • Qiang Cai
Editors
Endoscopic Therapy for
Gastroesophageal Reux
Disease
ISBN 978-981-95-5388-4 ISBN 978-981-95-5389-1 (eBook)
https://doi.org/10.1007/978-981-95-5389-1
© Shanghai Scientic and Technical Publishers 2026
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of reprinting, reuse of illustrations,
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information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
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The publishers, the authors, and the editors are safe to assume that the advice and information in this
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or the editors give a warranty, express or implied, with respect to the material contained herein or for any
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This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore
If disposing of this product, please recycle the paper.
Editors
Lianyong Li
Department of Gastroenterology
The Ninth Medical Center
of Chinese PLA General Hospital
Beijing, China
Qiang Cai
Gastroenterology Associates
Ochsner LSU Health Shreveport
Shreveport, LA, USA
Xinke Sui
Department of Gastroenterology
The Ninth Medical Center
of Chinese PLA General Hospital
Beijing, China
Jointly published with Shanghai Scientic and Technical Publishers
The print edition is not for sale in China (Mainland). Customers from China (Mainland) please order the
print book from: Shanghai Scientic and Technical Publishers.
v
Preface
Gastroesophageal reux disease (GERD), as a common upper digestive tract dis-
ease, has been troubling countless patients for a long time. Its symptoms, such as
heartburn, acid reux, and belching, not only seriously affect the patients’ daily life
quality but may also induce serious complications such as chronic pharyngitis,
esophagitis, and esophageal adenocarcinoma. Although traditional drug treatment
can alleviate symptoms, for some refractory patients, the effect is limited and often
requires long-term or even lifelong medication. With the continuous progress of
medical technology, endoscopic anti-reux surgery came into being, which has
brought new treatment hope for these patients.
Endoscopic anti-reux surgery is a safe and effective minimally invasive treat-
ment. It uses advanced endoscopic technology to enter the esophagus through the
mouth and can be performed without laparotomy. This kind of surgery not only has
less trauma and quick recovery but also can effectively avoid many complications
caused by traditional surgery. In recent years, with the continuous development and
improvement of endoscopic technology, endoscopic anti-reux surgery has become
one of the important methods for the treatment of GERD.
This book, Endoscopic Therapy for Gastroesophageal Reux Disease, aims to
comprehensively and systematically introduce the relevant knowledge of endo-
scopic anti-reux surgery. The operation principle, pre-operation preparation, oper-
ation steps, postoperative nursing, and complication prevention are discussed in
detail. The book not only contains the latest surgical techniques and research results
but also combines a large number of clinical cases, so that readers can more intui-
tively understand the practical application of surgery.
The publication of this book is of great signicance for promoting the develop-
ment of endoscopic anti-reux surgery. It can not only provide a platform for the
majority of medical workers to learn, communicate, and improve their surgical
skills and diagnosis and treatment level; it can also bring benets to the majority of
GERD patients, so that they can enjoy safer and more effective surgical treatment.
Endoscopic anti-reux surgery is an important innovation in the eld of medi-
cine, which brings new treatment options and hope for the majority of GERD
patients. We believe that with the continuous progress of medical technology and
vi
the wide dissemination of this book, endoscopic anti-reux surgery will be more
widely used and promoted, bringing health and happiness to more patients. Let us
work together to promote the development of medical cause to contribute our own
strength!
Beijing, China LianyongLi
Beijing, China XinkeSui
2025 April
Preface
vii
1 Epidemiology and Pathophysiology of Gastroesophageal Reflux
Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Guodong Wang
2 Endoscopic Fundoplication for Gastroesophageal Reflux Disease . . . . 15
Feng Du
3 Endoscopic Injection Therapy for GERD. . . . . . . . . . . . . . . . . . . . . . . . 35
Lei Liu
4 Anti-reflux Mucosal Resection (ARMS) . . . . . . . . . . . . . . . . . . . . . . . . . 51
Lianyong Li, Qiang Cai, and Rong Qin
5 Stretta Radiofrequency Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Lianyong Li, Qiang Cai, and Xinke Sui
6 Peroral Endoscopic Cardial Constriction (PECC) . . . . . . . . . . . . . . . . 73
Qian Yue
7 Evaluation of Endoscopic Treatment for GERD . . . . . . . . . . . . . . . . . . 83
Xin Huang
Contents
1© Shanghai Scientic and Technical Publishers 2026
L. Li et al. (eds.), Endoscopic Therapy for Gastroesophageal Reux Disease,
https://doi.org/10.1007/978-981-95-5389-1_1
Chapter 1
Epidemiology andPathophysiology
ofGastroesophageal Reux Disease
GuodongWang
1.1 Denition ofGERD
The 2006 Montreal Consensus denes gastroesophageal reux disease (GERD) as
a disease in which the reux of gastric contents causes unpleasant symptoms and/or
complications. The classication of GERD including of esophageal symptom syn-
drome and extra-esophageal symptom syndrome has been widely promoted and
applied internationally, promoting the expansion of GERD to other disciplines other
than gastroenterology [1].
In 1999 and 2005, the American College of Gastroenterology dened GERD as
esophageal mucosal injury caused by reux symptoms or abnormal reux of gastric
contents into the esophagus [2]. The 2006 Consensus on Gastroesophageal Reux
Disease was formulated by the Chinese Expert Group, which referenced interna-
tional consensus statements and combined the clinical realities of China. This docu-
ment proposed the denition and classication of gastroesophageal reux disease
(GERD) applicable to the Chinese context [3], and it remains in clinical use to date.
The key contents are specied as follows: 1. Denition: The consensus adopted the
recommendations of the Montreal Consensus, dening gastroesophageal reux
disease (GERD) as a disorder caused by the reux of gastric contents into the
esophagus, which results in bothersome symptoms and/or complications (Fig.1.1).
G. Wang (*)
Department of Gastroenterology, The Ninth Medical Center of Chinese PLA General
Hospital, Beijing, China
2
Fig. 1.1 Pattern of GERD
1.2 Clinical Typing ofGERD
According to endoscopic appearance, GERD can be divided into non-erosive reux
disease (NERD), erosive esophagitis (EE), and Barrett’s esophagus (BE), which is
also referred to as GERD-related disease [2, 4, 5]. Fass etal. [6] believed that the
three types of GERD were relatively independent, with no or little transformation
between each other, but some scholars believed that these three types might be cor-
related to some extent. NERD refers to the presence of discomfort symptoms asso-
ciated with reux, but no BE or damaged esophageal mucosa can be found under
endoscopy. EE refers to the damaged mucosa of the distal esophagus under endos-
copy. In 1999, the Los Angeles Conference proposed a clear EE grading standard,
which was divided into Grade A to D according to the severity of endoscopic esoph-
ageal lesions (Fig.1.2a) [7]. BE refers to the replacement of squamous epithelium
with columnar epithelium in the distal esophagus (Fig. 1.2b). Among the three
forms of GERD, NERD is the most common, EE can be associated with esophageal
stricture, ulcers, and gastrointestinal bleeding, and BE may develop into esophageal
adenocarcinoma. The correlation and progression of these three disease forms
require further study [6]. Clarifying the evolution rules between the three types is
conducive to the study of the pathogenesis of different types of GERD, so as to take
targeted treatment measures. More importantly, it is helpful to clarify the necessity
and cost-benet ratio of regular endoscopic follow-up for NERD and EE patients.
G. Wang
3
Fig. 1.2 RE and BE
1.3 Prevalence andIncidence ofGERD
1.3.1 Prevalence Characteristics ofGERD Symptoms
Globally, about 13% of people report GERD symptoms at least weekly, but there is
considerable geographic variation [8]. Precise estimates are difcult due to differ-
ences in study design, but the prevalence of GERD appears to be highest in South
Asia and southern Europe (more than 25%), and lowest in Southeast Asia, Canada,
and France (less than 10%) [8]. Current data show that the prevalence of typical
symptoms of GERD in China is 2.5%–7.8%, lower than that in North America
(18.1%–27.8%) and Europe (8.8%–25.9%) [9]. But there are no data on the preva-
lence of GERD in Africa to date. Estimated prevalence of GERD symptoms in the
United States range from 6% to 30%, with specic data related to the questionnaires
used, including threshold frequency and duration of symptoms judged to have
achieved GERD [10]. The weekly incidence of GERD symptoms in the United
States is about 20% [11], about 110,000 GERD patients are hospitalized every year
[12]. Importantly, the prevalence of GERD symptoms increased by about 50% in
North America, Europe, and Southeast Asia compared with the baseline prevalence
in the mid-1990s, but had leveled off [11]. A longitudinal study based on a popula-
tion in a region of Norway showed that from 1995 to 2009, the annual incidence of
GERD was 3.1% and the incidence of severe GERD symptoms was 0.2% based on
the occurrence of any new GERD symptoms [13]. In any patient with GERD,
excluding those taking anti-reux drugs, the rate of automatic remission was 2.3%
per year, while in patients with severe GERD, spontaneous remission occurs in
1.2% of patients each year.
1 Epidemiology andPathophysiology ofGastroesophageal Reux Disease