The Randomized EsophyX vs Sham, Placebo-Controlled Transoral Fundoplication (RESPECT) trial demonstrates that transoral oesophagogastric fundoplication (TF) is effective in reducing symptoms of regurgitation in proton pump inhibitor (ppi)-resistant patients

▸ Philip Hendy reviews Hunter et al.1

While ppi therapy has a high efficacy in treating heart burn, its impact on oesophageal regurgitation is considerably more modest.2 Laparoscopic fundoplication (LF) can be an effective treatment, but there is a low referral rate (<10% of the qualifying group) because of patient and physician factors.3 TF is a non-incisional, endoscopic procedure which involves folding the stomach anteriorly around the oesophagus and securing it with multiple fasteners to increase sphincter potency. Retrospective data series have shown TF to be effective at improving gastro-oeosophageal reflux disease (GORD), including regurgitation, but until now prospective randomised controlled trial data are lacking.

Patients with troublesome regurgitation (defined as moderate or severe symptoms more than once per week or mild symptoms two or more times per week as per …