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Digestive Health Special Report

On the Horizon: Two New Surgical Treatments for GERD

For the vast majority of Americans who suffer from gastroesophageal reflux disease (GERD), medication alone is enough to treat their symptoms. But up to 20% of people are not helped by GERD medications.

Some of these people -- or those who don't want to be on long-term medication -- may turn to surgery, most commonly a procedure called a Nissen fundoplication. However, this invasive procedure is not without side effects, and it also fails to correct GERD in up to 20% of patients. As a result, researchers are investigating less invasive and more successful ways to resolve the symptoms of GERD and correct its cause.

The main reason for GERD is weak muscular tension in the gastroesophageal sphincter, which is the valve that separates the stomach from the esophagus. This valve is supposed to stay closed unless you're swallowing food or liquids. But if the muscle becomes weakened and the valve opens from time to time, stomach contents can escape upward into the esophagus, causing the familiar symptoms of GERD: heartburn and indigestion. If left untreated, this reflux can eventually damage the esophagus and lead to serious complications such as esophageal ulcers and strictures, Barrett's esophagus (a disorder of the cells lining the esophageal mucosa), and esophageal cancer.

Two new surgical procedures aim to strengthen the esophagus and reconstruct an antireflux valve -- therefore ending both GERD and the need for daily medication. They're both less invasive than either traditional or laparoscopic Nissen fundoplication, and they do show promise.

Transoral Incisionless Fundoplication (TIF) for GERD
This procedure, performed with a device known as the EsophyX, is just what its name suggests: a surgical treatment that does not involve any incisions. TIF is performed under general anesthesia. The surgeon inserts the device through the throat and into the esophagus to the gastroesophageal junction where the stomach and esophagus meet.

The EsophyX then forms and secures several tissue folds (or plications) to create a valve at the gastroesophageal junction. Since it is incisionless, TIF may have an advantage over traditional or laparoscopic Nissen fundoplication, as recovery time and pain can be significantly lessened. And since TIF is less invasive, it can be repeated or reversed if necessary -- an important consideration given the relatively young age of many GERD sufferers.

Magnetic Sphincter Augmentation for GERD
In this procedure, rather than using the body's own tissue to create a stronger gastroesophageal sphincter, a ring of miniature metal beads is inserted around the sphincter to add extra pressure. A surgeon needs to make only a small laparoscopic incision. He or she then wraps a series of magnetic beads, in the shape of a bracelet, around the bottom of the esophagus. The device, known as the LINX Reflux Management System, is sized to fit each patient. Once it is in place, magnetic attraction keeps the beads together and helps it to keep the gastroesophageal sphincter closed. The valve can still open while swallowing food or belching. Because the procedure is so minimally invasive, it is considered outpatient surgery, and most people can return to a normal diet the following day.

The Bottom Line: The EsophyX device has been approved by the U.S. Food and Drug Administration and is being used at hospitals throughout the country, but the LINX Reflux Management System is still in clinical trials.

Posted in Digestive Health on July 5, 2010

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