Although there can clearly be an argument regarding the threshold at which it becomes a disease, gastro-oesophageal reflux disease (GORD) is ultimately the result of excessive gastro-oesophageal reflux and the associated consequences of that. It then seems rather straightforward that therapeutic interventions should seek to reduce or eliminate gastro-oesophageal reflux. The paradox is that the dominant medical interventions do not; rather, they alter the content of the refluxate (by inhibiting gastric acid secretion) so as to make it less noxious to the oesophageal epithelium. This, in a nutshell, summarises the decades old argument regarding the relative merits of medical verses surgical therapy for GORD. Or so it was, until the dawn of the era of endoluminal therapies for GORD a few short years ago. Now it seems that physicians have assumed some attributes of their surgical colleagues as they experiment with therapies that target the reflux itself.

The Gatekeeper reflux repair system is the fifth endoluminal therapy for GORD to gain regulatory approval either in the European …