The medical and endoscopic management of failed surgical anti-reflux procedures

Surgical anti-reflux procedures, both open and laparoscopic, when performed by an experienced surgeon have been shown to be extremely effective in eliminating the major symptoms (heartburn and regurgitation) associated with gastroesophageal reflux disease (GERD) as well as heal erosive esophagitis and prevent stricture. The results of surgical anti-reflux surgery have also demonstrated durability in maintaining symptomatic and endoscopic remission in most of the patients who have an initial response. However, not all patients exhibit an initial or permanent satisfactory outcome from surgery, and surgical failure is even more prevalent when surgery is performed outside community and academic anti-reflux surgery centers of excellence. Thus, both the anti-reflux surgeon and his/her gastroenterology colleague likely will see an increasing number of their own or other physicians? patients that either failed to obtain initial symptom relief after anti-reflux surgery or whose symptoms have returned after an initial symptomatic improvement following their operation. This chapter will discuss the medical and endoscopic management of these patients and leave the surgical management of such patients for Drs. Kieran and Curet to discuss in Chapter 11 of this book.