Endoscopic Anti-Reflux Procedure

Reflux can be a troublesome issue following some forms of bariatric surgery, especially the laparoscopic sleeve gastrectomy (LSG). Often, medications and lifestyle measures fail to control reflux symptoms completely.

Endoscopic Anti-Reflux Procedure

History of reflux surgery

The traditional management of refractory (ongoing despite treatment) reflux is a surgical procedure called a laparoscopic fundoplication. This is usually not possible following most types of bariatric surgery due to changes in the anatomy.

If further surgery is recommended following the LSG, Roux-en-Y gastric bypass (RYGB) can be performed by your bariatric surgeon. This type of revisional bariatric surgery may be technically very challenging and can pose risk of early and late complications including long-term nutritional deficiencies.

What is RAP?

A relatively novel endoscopic approach called the Resection and plication Anti-reflux Procedure (RAP) combines existing techniques used in advanced endoscopic procedures. RAP results in reconfiguring and tightening the lower oesophageal sphincter (LOS).

Dr Gupta has been performing the RAP for the last few years – he is the first interventional gastroenterologist in NSW and the second in the country to perform this highly specialised procedure.

RAP can significantly improve reflux in selected individuals, and a diagnostic endoscopy is initially required to ensure appropriate anatomy. It is generally performed as a same-day procedure under general anaesthetic, and takes approximately one hour.

As with any advanced technique, certain specific procedure related risks exist – these will be discussed in detail during your consultation with Dr Gupta.

DISCLAIMER: The following is a real medical procedure. It is age-restricted which requires you to click the "Watch on Youtube" link to view.

The information provided here is for general educational purposes only. If you would like to know if an anti-reflux procedure is appropriate for your situation, please contact Sydney Gastroenterology & Liver Group.


Benias PC, D'Souza L, Lan G, Gluckman C, Inamdar S, Trindade AJ, Miller LS, Carr-Locke DL. Initial experience with a novel resection and plication (RAP) method for acid reflux: a pilot study. Endosc Int Open. 2018 Apr;6(4):E443-E449. doi: 10.1055/s-0044-101453. Epub 2018 Mar 29. PMID: 29607397; PMCID: PMC5876037.

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