Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder, with increasing prevalence due to obesity and lifestyle changes. Although proton pump inhibitors (PPIs) remain the first-line therapy, a proportion of patients have an unsatisfactory response, require long-term medication, or experience symptom relapse after discontinuation. Positioned between pharmacotherapy and surgery as a third therapeutic option, endoscopic therapy offers an additional choice for patients with refractory GERD. Based on current evidence, this article examines the optimal timing of endoscopic intervention, with particular attention to intervention after PPI failure, indications for endoscopic therapy, and individualized strategies for special populations. It also summarizes limitations of the existing evidence and outlines priorities for future research, including the need for long-term follow-up, robust cost-effectiveness evaluation, and exploration of biomarkers to inform timing decisions. In summary, evidence-based and individualized selection of intervention timing is essential to optimize the therapeutic efficacy of endoscopic management for GERD.

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder, with increasing prevalence due to obesity and lifestyle changes. Although proton pump inhibitors (PPIs) remain the first-line therapy, a proportion of patients have an unsatisfactory response, require long-term medication, or experience symptom relapse after discontinuation. Positioned between pharmacotherapy and surgery as a third therapeutic option, endoscopic therapy offers an additional choice for patients with refractory GERD. Based on current evidence, this article examines the optimal timing of endoscopic intervention, with particular attention to intervention after PPI failure, indications for endoscopic therapy, and individualized strategies for special populations. It also summarizes limitations of the existing evidence and outlines priorities for future research, including the need for long-term follow-up, robust cost-effectiveness evaluation, and exploration of biomarkers to inform timing decisions. In summary, evidence-based and individualized selection of intervention timing is essential to optimize the therapeutic efficacy of endoscopic management for GERD.