Novel Endoluminal Clinical TreAtment of Reflux

Inclusion Criteria:

   1. History of heartburn-like pain, regurgitation, or both prior to the initiation of
   proton pump inhibitor (PPIs) therapy.

   2. History of GERD symptoms of at least six months despite continuous PPIs.

   3. GERD-HRQL score ≥15 after discontinuing PPI therapy.

   4. GERD-HRQL score improvement of at least 6 points while on PPIs, with at least 4-point
   improvement in heartburn subscore.

   5. A minimum GERD-HRQL score while on PPIs of 2.

   6. Pathologic acid exposure time, a baseline pH <4.0 for ≥ 5.3% of time during a 48-hour
   evaluation period.

   7. Twenty two years of age or older.

   8. Life expectancy of at least two years.

   9. Willing and able to return to the clinic or hospital for all evaluation procedures
   scheduled throughout the course of this study.

10. Is capable of understanding clinical study procedures and giving informed consent.

Exclusion Criteria:

   1. Unable to tolerate an endoscopic procedure

   2. Presence of esophageal or gastric varices

   3. Presence of erosive esophagitis (LA Classification of C or D)

   4. Presence of a hiatal hernia > 2 cm

   5. Presence of Barrett's esophagus

   6. Presence of esophageal motility disorder

   7. History of or known esophageal stricture or gross esophageal anatomic abnormalities

   8. Symptoms of dysphagia more than once per week within the last six months

   9. Obesity (BMI ≥ 35)

10. Gastric or esophageal cancer undergoing active treatment

11. Received radiation therapy to the esophagus and has fibrosis of the tissue at the
   likely injection sites

12. Had an ablation procedure in the lower esophageal sphincter area

13. Has a condition that could lead to significant postoperative complications, including
   current infection, anticoagulant use, uncontrolled diabetes or autoimmune disorder

14. Enrolled in a concurrent clinical trial

15. Inability to comply with study protocol due to a chronic disease, psychiatric illness,
   alcoholism, drug abuse, or geographic distance (as determined by investigator)

16. Pregnant and/or given birth in the previous twelve months or who plan to become
   pregnant in the next twelve months

17. Prior gastric or GERD surgery