Transoral Incisionless Fundoplication (TIF) Versus Sham for Treatment of Gastroesophageal Reflux Disease (GERD)

Inclusion Criteria: * Age 18-80 years * On daily PPIs for \> 6 months * Documented PPI dependency * Persistent GERD symptoms without PPI therapy during the titration phase of the study * Evidence of two or more of the following while off PPI therapy (\> 10 days): * Erosive esophagitis (Los Angeles grade A-C) * Abnormal ambulatory pH study * Moderate to severe GERD symptoms * Normal or near normal esophageal motility (by manometry) * Patient willing to cooperate with post-operative dietary recommendations and assessment tests * Signed informed consent Exclusion Criteria: * BMI \> 35 * Hiatal hernia \> 3 cm * Esophagitis LA grade D * Esophageal ulcer * Esophageal stricture * Barretts esophagus (Prague: C\>1, M\>2) * Esophageal motility disorder * Severe gastric paralysis * Pregnancy or plans for pregnancy in the next 12 months * Immunosuppression * ASA \> 2 * Portal hypertension and/or varices * History of previous resective gastric or esophageal surgery, cervical spine fusion, Zenker's diverticulum, esophageal epiphrenic diverticulum, achalasia, scleroderma or dermatomyositis, eosinophilic esophagitis, or cirrhosis * Active gastro-duodenal ulcer disease * Gastric outlet obstruction or stenosis * Severe gastroparesis or delayed gastric emptying confirmed by solid-phase gastric emptying study if patient complains of postprandial satiety during assessment * Coagulation disorders