Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder with a high prevalence, often resulting in significantly reduced quality of life for patients. When standard medication does not provide adequate relief, it is referred to as refractory GERD. In recent years, new endoscopic treatments, such as ARMS (anti-reflux mucosectomy), ARMA (anti-reflux mucosal ablation), ARMP (anti-reflux mucoplasty) and ESD-G (endoscopic submucosal dissection for GERD), have been developed. From the surgical perspective, options like laparoscopic anti-reflux surgery (e.g., Nissen fundoplication) are considered when endoscopic treatments are not sufficient. Furthermore, in the diagnosis of GERD, the development of EPSIS (endoscopic pressure study integrated system) has made it possible to easily evaluate the function of the lower esophageal sphincter (LES). This session would like to provide an opportunity for deeper discussion on the endoscopic management of refractory GERD by soliciting presentations from both the fields of internal medicine and surgery.