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September 7, 2004
New treatment option for gastro-reflux disease

BY cindy sanders

Gastrointestinal surgeons at Crawford Long and Emory hospitals are among the first in the world to treat patents suffering from gastroesophageal reflux disease (GERD) with a simple, outpatient endoscopic procedure that takes less than an hour.

GERD is a term used to describe the variety of symptoms and forms of tissue damage resulting from chronic reflux of stomach contents into the esophagus. One of the most common symptoms of GERD is heartburn, caused when acids reflux (flow backwards) from the stomach into the esophagus, causing inflammation. More than 15 million Americans suffer from daily heartburn.

“I’m very excited about this new technique to treat GERD,” said Edward Lin, assistant professor of surgery. “Reflux can be a very debilitating condition, and this procedure gives patients a viable option to surgery and costly medications.”

According to Lin, the new procedure is different from traditional surgery, where part of the upper stomach is wrapped around the esophagus to create a new anti-reflux valve from the exterior of the gastroesophageal junction. The new technique is a full suturing method that attempts to create a ‘ball-valve’ anti-reflux barrier from inside the upper stomach completely using endoscopy.

The technique uses a device consisting of a reusable instrument called a Plicator, a single-use cartridge containing a suture-based implant, and a specially designed endoscopic tissue retractor. The device is passed orally into the stomach over a guidewire and sutures the inside of the stomach at the gastroesophageal junction to tighten the valve, stop reflux and restore the natural anti-reflux barrier.

Normally, a muscular valve at the end of the esophagus keeps stomach contents from refluxing into the esophagus. However, in GERD, this valve is weak or relaxes too frequently, allowing stomach contents to flow freely into the esophagus.

Currently, treatments for GERD fall into three categories: medications, surgery and endoluminal (by endoscopy) therapy such as the Plicator. The Plicator is one of four endoluminal therapies currently approved by the FDA and available at Emory. The main differences with the Plicator procedure is that it instantly creates an internal valve at the gastroesophageal junction with full-thickness suturing, and can be performed quickly.

“This may not always offer a complete cure, but neither does surgery,” Lin said. “Because it is comparatively new, the outcomes data for the new procedure are still being evaluated. However, the new procedure does not complicate future treatment or surgery for patients who do not experience relief. Our goal is to offer our patients relief from GERD, and we are able to do it now using the full spectrum of available modalities including a quick, minimally invasive outpatient procedure.”

Lin said patients typically go home an hour after the procedure and start experiencing relief from reflux within a month.

“This is appropriate for our complicated patient population—especially those who cannot undergo an invasive surgery or choose an intermediate procedure between medications and surgery,” Lin said.

Some people with complex esophageal conditions, such as giant hiatal hernias and rare esophageal motor problems, are not candidates for the procedure, he added.

Most insurance plans cover the procedure, which the FDA approved in April 2003. Endoluminal therapy is markedly less expensive than surgery, and medications can cost as much as $2,000 a year. Costs of GERD treatment exceed $9.3 billion each year in the United States.

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