To investigate the value of endoscopic suturing in reflux esophagitis and the safety of this procedure. METHODS: Eleven cases of GERD (including two cases of post-pancreatic resection GERD) diagnosed by endoscopy, esophageal ph test, esophageal manometry, clinical symptoms and proton pump inhibitor dependence were treated with endoscopic pancreatic suturing using the American BARD endoscopic suturing system, and the short-term efficacy and safety of the procedure were evaluated by observing the preoperative and postoperative GERD scores and complications of the procedure. The short-term efficacy and safety of the procedure were evaluated. RESULTS: A total of 26 stitches and 13 knots were sutured in 11 patients, including 4 longitudinal sutures and 9 circumferential sutures. The postoperative symptoms were completely relieved in 5 cases, partially relieved in 4 cases, and ineffective in 2 cases. No significant complications occurred in the patients intraoperatively or postoperatively, except for a little blood leakage from the needle holes at the suture site during the operation. Conclusion: The recent efficacy of endoscopic suturing is reliable and safe, and the long-term efficacy needs further study. Some patients with reflux esophagitis have poor suburban outcomes with medical treatment and often need to rely on proton pump inhibitor therapy, which is economically costly for patients and can cause a series of side effects and great pain for patients with long-term drug dependence. Patients with this disease often have a relaxed cardia, and gastric juice tends to flow back into the esophagus. Endoscopic suturing is performed using a special endoscopic suturing system, the bard endocinch, to endoscopically suture the cardia mucosa in place of surgical fundoplication, thereby reducing the cardia and preventing GERD. This method is simple and low cost compared to surgery, and the suture is reversible, and the suture can be removed if there is discomfort after the suture. 1. Materials and methods 1.1 Subjects: 11 cases of esophageal reflux disease, 8 males and 3 females, aged 35-56 years, with a duration of 1-5 years, including 2 cases of gastroesophageal reflux after cardia resection. All cases had esophageal acid reflux or heartburn symptoms more than 3 times a week, which were relieved by medication and recurred after stopping medication. Acid reflux was proved by 24-h pH measurement of the esophagus. There was cardia relaxation by endoscopy, cardia diastolic diameter was greater than 1.6 cm, and there was frequent diastolic state by endoscopic observation. 1.2 Materials: Olympus XQ-200 electric endoscope, American BARD II suture, Danish Medtronic gastrointestinal dynamic pH monitor. 1.3 Methods: All cases were monitored by endoscopy, barium meal fluoroscopy, and esophageal pH, and met the diagnostic criteria of reflux esophagitis, and the endoscopic manifestations of esophageal mucosa, the size of the cardia, the number of heartburn, and the number of reflux were recorded, and then a comprehensive preoperative esophagitis score was performed for each patient and the preoperative score was studied against the postoperative score. The diagnosis and scoring criteria were as follows: diagnosis referred to the grading criteria proposed by the 1999 Yantai meeting of the Society of Gastrointestinal Endoscopy of the Medical Association [1]; GERD symptom score referred to the Savary-miller scoring system: number of heartburn: 0, none; ①occasionally and briefly, controlled by antacids; ② frequently, 3-5 times/week; ③ daily and painful, 6-7 times/week. Reflux score: 0, none; ① mild, occasional, mainly after meals but unpredictable; ② moderate, frequent, 3 to 5 times/week, induced by position change; ③ severe, 6 to 7 times/week daily, affecting work and daily life. 1.4 Suture: The patient’s bleeding and clotting time and cardiopulmonary function must be routinely examined before surgery. Two gastroscopes must be prepared, one for the suture and one for the knot tying device. The operation is performed under painless, firstly anesthesia is administered, an esophageal trocar is placed under the endoscope, a gastroscope with a loaded suture is inserted to draw the negative mucosal pressure into the lumen of the suture, the suture handle is pressed down firmly, the metal pendant with suture is passed through the inhaled mucosa, the suture and the metal pendant are carefully withdrawn to complete a stitch of suture, and the above action is repeated for suturing. The suture is divided into circular suture and longitudinal suture. The circular suture is folded under the dentate line along the perimeter of the cardia, and the longitudinal suture is folded under the dentate line of the cardia along the side of the gastric lesser curvature, with 2 to 3 stitches for each fold, and the knot is tied with another gastroscope fitted with a knotter after one fold. Depending on the size of the cardia, 1 to 2 folds are sutured. Each fold was 1.5 to 2 cm apart. 2. Results A total of 26 stitches and 13 knots were sutured in 11 patients, including 4 longitudinal sutures and 9 circumferential sutures. Two cases were sutured with two knots due to the cardia opening larger than 3 cm. All patients were operated under isoproterenol anesthesia and the operative time was 20-35 min, with a mean of 27 min. all patients were allowed to have a liquid diet 3 h after surgery. At the postoperative follow-up of three months, 5 cases had complete remission of symptoms, 3 cases had partial remission, and 2 cases were ineffective. The mean preoperative heartburn score was 2.67 and 0.67 after 3 months. the mean reflux score was 1.67 and 0.56 at 4 months postoperatively. intraoperative congestion of the aspirated mucosa was seen, and a small amount of blood oozed from the needle hole, all of which were able to self-clot. The patients’ respiration, heart rate and blood pressure were stable during the whole procedure. After surgery, 6 cases felt mild pulling discomfort in the upper abdomen, which was relieved after 3 days. 8 cases felt different degrees of pain and discomfort in the throat, which were relieved after 2 d. Some patients need to take proton pump inhibitors for a long time, which is costly and easy to cause side effects. It causes great pain to patients, and some patients choose surgical treatment, but its high cost, surgical trauma, and postoperative modifications are not possible. The endoscopic suture device was first developed by Swain and Mills in 1986 and first used in clinical treatment of GERD in 2001. The Bard suture device used in our group is a suture device installed at the front of the endoscope, and the gastric mucosa is sutured and folded under direct endoscopic view, increasing the length of the lower esophageal sphincter by circular sutures and increasing the pressure of the lower esophageal sphincter by linear sutures. In our group of 11 patients, the symptoms were completely relieved in 5 cases, partially relieved in 4 cases, and ineffective in 2 cases at the postoperative follow-up of 3 months. The efficiency rate was approximately the same as that reported by Yang Yunsheng et al [2]. The postoperative heartburn score and reflux score both decreased significantly, showing satisfactory recent efficacy. Some patients had mild postoperative abdominal pulling discomfort and pharyngeal pain, but they were not serious and were able to recover on their own, showing that there were no serious complications from this procedure. We appreciate that the first step in performing this procedure is to select the right case, and for the indications of this procedure, Miao Lin et al. believe that grade 2 to 3 esophagitis is more appropriate, while grade 4 esophagitis is prone to mucosal bleeding, which affects the surgical field and increases surgical complications [3], and Filipi et al. believe that dysphagia, grade 3 or 4 esophageal hiatus hernia with a length greater than 2 cm are not considered as indications [4]. In our opinion, the indications for this operation are mainly for patients with grade 2 to 3 reflux esophagitis who have poor efficacy of medications for esophagitis or need to take PPI for a long time, and for grade 4 esophagitis, the pros and cons should be weighed and medication can be performed first, and if medication improves, then surgery can be performed after treatment, and if the effect of medication is unsatisfactory, it is not impossible to perform this operation, because the sutured mucosa is under the dentate line and is generally not affected by The sutured mucosa is under the dentate line and is usually not affected by inflammation, which does not increase the chance of cutting. If necessary, norepinephrine saline can be administered if it affects the surgical field. Whether this procedure can be performed for post-pancreatic resection reflux or not is a question of whether it can be performed in two of our patients, one with complete remission and one with no effect, so its applicability needs further investigation. For the successful performance of this procedure, we have learned that, first, the surgeon should have a good foundation in endoscopic operation and should prepare two gastroscopes, one with a suture and one with a knot tying device. This can avoid the disassembly of instruments and reduce the operation time. Secondly, the mucosa should be attracted in place, and the space at the head of the suture should be sucked full as much as possible. The pulling wire of the assistant should be slightly relaxed when withdrawing the suture, and should not be pulled tightly, otherwise the side can lead to mucosal cutting. This group was operated under painless endoscopy, and necessary vital sign monitoring should be performed during the procedure. Although there was no intraoperative respiratory distress in this group, there were reports of patients with respiratory distress caused by the procedure when they had a cold [2], so the procedure should be slowed down for those with respiratory tract infection.