Aim: to evaluate the short term results of EndoLuminal Fundoplication (ELF) with EsophyxTM in a group of patients treated for gastroesophageal reflux disease. Method: 64 patients presenting during the period June 2006 - April 2008 with a history of chronic reflux esophagitis (>6 months), with either endoscopic or pH-metric diagnosis, needing long term acid suppressive therapy, were asked to take part to the study. Patients with a hiatal hernia larger than 3 cm or Barrett esophagus were excluded. Twenty patients (median age 47.5 yrs) were included into the study. ELF procedures were performed under general anesthesia with orotracheal intubation by expert endoscopist and surgeon.Results: Twelve patients (60%) had a small hiatal hernia (<3 cm); 5 had LA grade B/C esophagitis. The median total reflux time was 2.5%. The mean duration of the procedure to construct a 220° valve (range 180-270°) was 62 minutes. A median of 14 fasteners (range 6-18) were placed. There were no major intraoperative complications. Two patients had an haematemesis on the 1st and 8th postoperative day, which needed prolonged or re-hospitalization and were treated conservatively (major complication: 10%). Fifteen patients have reached a 6 month follow up and 7 a 12 month follow up. Symptom improvement was 60% at 6 months and 57.1% at 12 months. GERD-HRQL score decreased from a median of 43 to a median of 7 (p <0.005, Mann-Whitney U test); one patient still had grade B esophagitis at 6 month follow up; at physiopatologic evaluation improvement was recorded in 16.6% of cases, while 16.6% remained unchanged, and 66.7% worsened at one year follow up. Six patients (30%) with persistent symptomatic reflux underwent laparoscopic Nissen fundoplication with good results.Conclusion ELF is maybe the most attractive endoscopic technique for GERD. Patients treated with the procedure had a symptom improvement but laboratory results at 6 and 12 months on gastro-esophageal reflux are unsatisfactory and there is a high number of reoperations. We therefore conclude that ELF with EsophyxTM is an investigational procedure with no role in routine treament of GERD.