The indications and limits of a novel endoluminal fundoplication (ELF) technique using a trans-oral and fastener-deploying device (EsophyX, EndoGastric Solutions) for the treatment of gastroesophageal reflux disease (GERD) are well-described with pictures and videos in this key lecture. The EsophyX device was shown to be safe, and capable of deploying fasteners directly into tissue and forming an interrupted suture line at the base of the gastroesophageal valve (GEV). First good results and follow-up at 12 months in a series of 17 patients are shown.