If you have severe acid reflux disease and don't want to have to take a pill for the rest of your life, you may have considered the next step—endoscopic surgery.
While many people cringe at the thought of surgery, new techniques offer a shortcut to surgically treating gastroesophageal reflux disease (GERD). Instead of cutting your stomach open, surgeons insert a small scope through the mouth to get to the abdomen.
"These endoscopic procedures are less invasive than surgery and offer a reduced risk and more rapid recovery," said Dr. Yang Chen, professor of medicine at the University of Colorado Hospital in an editorial published in July 2005 in Gastrointestinal Endoscopy.
But a recent recall of one of these endoscopic devices raises question as to the long-term safety and success of these procedures.
Holding Back the Acid
Reflux disease occurs when the muscles at the junction of the stomach and the esophagus do not function properly. So, the acid in the stomach may flow past the stomach opening into the esophagus, causing damage to its lining. Over time, GERD symptoms will develop, causing chronic heartburn or the bitter taste of acid in the throat.
Endoscopic surgical techniques all work by trying to constrict the entryway from the esophagus to the stomach, limiting the amount of acid that can flow through.
These procedures, however, have come into doubt with the recent recall of the Enteryx method, a technique that allowed doctors to inject a special liquid into the walls of the esophagus. The liquid would then solidify, tightening the opening between the stomach and esophagus. Of the procedures that are in use, Enteryx seemed the most promising.
"If anything seemed like it would stand the test of time, it would be Enteryx," says Dr. Philip Katz, chairman of the division of gastroenterology at Albert Einstein Medical Center in Philadelphia.
One study even showed that over 85 percent of patients who had the surgery had discontinued using proton-pump inhibitor drugs (PPIs), like Prilosec and Nexium, a year after the surgery.
But the manufacturer recalled Enteryx on September 23, 2005, citing a limited number of cases where the liquid spread throughout the gastrointestinal wall, causing serious inflammation of the lining of the lung.
Now that Enteryx is no longer available, patients have to look to other procedures that have lower success rates.
Other Options Less Promising
Older types of endoscopic surgery, called gastric plication, use stitches to create folds in the esophagus's opening, cinching it in like pleats in a pair of pants. The surgery can be performed with a few different suturing methods that have varying levels of success.
The EndoCinch method, for example, uses a special tool that lets a doctor place small sutures in the lining of the esophagus. However, in a review published in 2005 in the Journal of Thoracic and Cardiovascular Surgery, researchers found that up to 50 percent of patients were still taking PPIs a year after the EndoCinch surgery.
Similarly, the Plicator method creates a layer of sutures that encompass the entire wall of the esophagus to pull it in. In theory, these stitches can hold the folds of the esophagus more strongly than other forms of suturing.
"[One report] stated that PPI use was discontinued in 68 percent of the patients after 12 months," stated Dr. Soji Ozawa, lead author of the review from the School of Medicine at Keio University, Japan.
But Ozawa and her colleagues also reported that the since the Plicator method had relatively high occurrences of side effects, including chest, neck and abdominal pain, "the safety of this procedure must be further examined," she wrote. "[But] the sutures are expected to be quite durable, making this method a promising treatment for GERD."
The Stretta procedure, approved in 2001, works differently. A doctor sends a deflated balloon equipped with electrodes down the esophagus. After inflating the balloon at specific points, doctors send radiofrequency energy through the electrodes. This energy scars the region, thereby narrowing the esophagus walls.
"I stopped doing this procedure, because I was under-whelmed by the results," says Katz, who went on to explain how even though 70 percent of his patients would no longer be taking PPIs a year after the surgery, most were taking them again by two years.
Making a Decision to Have GERD Surgery
The only people who should be considering one of these procedures, according to Katz, is a patient who "has reflux that is well controlled by a medication, but who chooses not to continue taking the medication because of cost or concerns about taking a drug long-term."
If your GERD cannot be controlled by a prescription, says Katz, you need to find out if you have a more serious problem than acid reflux. In these cases, the surgery won't help anyway.
But for those who do think that one of these surgical procedures is best for them, it is important to understand that no one can truly say that any one of the techniques is better than another.
"It all comes down to the doctor's personal preferences," says Katz.
Worse, there is little long-term data on any of the techniques, and many patients report having to go back to PPI treatment a year after their surgery.
"How much risk do you take for a few years of no pills?" asks Katz.
©2007 Healthology, Inc.