Clinical Research Directory

Inclusion Criteria: 1. Patients after laparoscopic fundoplication procedure by Nissen (total, 360°), Dor (anterior, 180°) or Toupet (posterior, 270°) for gastroesophageal reflux disease no later than 10 years before enrolment. 2. Refractory (\> 6 months) and severe dysphagia after fundoplication procedure defined as an Eckardt score ≥3 and Mellow - Pinkas score ≥2 at baseline. 3. X-ray (contrasted radiographic examination of the esophagus) characterized by both: a.) tapered narrowing of the distal esophagus and GEJ; b.) partial/total stagnation of the contrast solution above the GEJ 4. Endoluminal planimetry: EGJ-DI \< 3 mm2/mmHg (with 40ml) 5. Age above 18 years 6. Signed informed consent form Exclusion Criteria: 1. No previous attempt with at least one prokinetic drug 2. Previous esophageal myotomy (open, laparoscopic or endoscopic) 3. Primary esophageal motility disorder (achalasia etc.) 4. Active erosive esophagitis 5. Active peptic ulcer disease 6. Esophageal stricture (peptic, malignant, other) 7. Partial or complete supradiaphragmatic migration of the wrap and/or stomach (Hinder Type III - IV), Large hiatal hernia more than 5 cm 8. Known eosinophilic esophagitis 9. Severe coagulopathy 10. Esophageal or gastric varices 11. Advanced liver cirrhosis (Child B or Child C) 12. Pregnancy or puerperium 13. Malignant or pre-malignant esophageal diseases (dysplasia): patients with a history of such disease after its cure are eligible for enrolment 14. Any other condition, which in the opinion of the investigator would interfere with study requirements 15. Known gastroparesis