Upper Gastro-intestinal endoscopy is key in the diagnosis and classification of gastro-esophageal reflux disease (GERD). In the near future endoscopy may play an important therapeutic role with several endoscopic antireflux techniques that have been developed.

The indications for EGD in patients with GERD are well defined. Patients with reflux esophagitis have endoscopic and/or histopathologic changes of esophageal mucosal injury and inflammation which should be systematically described and graded using accepted classifications to grade disease severity from simple esophagitis (Los Angeles or de Savary-Miller classification) to more severe findings such as Barrett’s esophagus (Prague classification).

Endoscopy plays also a crucial role in the diagnostic work-up of anti-reflux surgical failures and complications providing key information regarding the clinical strategy in these complex patients and should therefore be performed by operators who have a clear understanding of modified surgical anatomy following fundoplication.

Several endoscopic antireflux techniques have been developed over the last 20 years. Due to limited effectiveness, inadequate patients selection and/or severe complications, most of these procedures, have not survived the market. Some procedures have had limited success. Nevertheless endoluminal treatment of GERD is evolving and recent technological developments have produced promising results in appropriately selected patients.