Who are the ideal candidates for the new procedure for GERD?
Dr. Melvin: Most people with reflux are treating with antacid pills and they work quite well for a lot of patients, but some patients can’t continue to take the medication — either they can’t afford it, they have side effects or they just don’t want to be on a pill every day. Other patients don’t have good symptom relief with the medication alone. Those are really the two groups of patients that do quite well with the procedure that rebuilds the bottom of the esophagus and stops acid reflux.
How does the procedure work?
Dr. Melvin: For most patients with reflux disease who need some kind of procedure, they used to get surgery; that could be laparoscopic surgery. People did get quite well with it and bounced back. Now, there’s a new procedure where we use an instrument called Esophyx that goes down the mouth, without any incisions, and rebuilds the bottom of the esophagus where it enters the stomach by placing fasteners into the area, creating a valve there that prevents acid reflux.
What causes acid reflux?
Dr. Melvin: Most patients with symptoms of heartburn or reflux get those symptoms because acid that’s supposed to stay in the stomach gets into the esophagus. In normal people, there’s a valve in the bottom of the esophagus that keeps that acid there. When that doesn’t work anymore, people can get heartburn and they get burning in the inside the esophagus, which can actually cause damage that can lead to cancer.
How are you rebuilding the valve?
Dr. Melvin: The Esophyx device is a mechanical device that allows the surgery. It is actually inserted into the mouth. It goes into the stomach and is able to rebuild that valve of the esophagus where it goes into the stomach. With a scope that goes through it, you can see it happen and we can individually tailor the valve as needed for different patients.
Why is this procedure considered an advancement?
Dr. Melvin: A patient with reflux has the option of having traditional surgery, which, while done laparoscopically, can still cause some disability. This is done down the mouth so it’s less invasive than even traditional surgery. It’s still a reasonable step and it’s not for everybody, but it’s very effective for patients who either require medication everyday or don’t get good relief.
What patients is the procedure recommended for?
Dr. Melvin: Many patients with reflux have a hiatal hernia — a large opening in the diaphragm muscle. Those patients — if they don’t get good relief — probably need the traditional laparoscopic surgery to rebuild that whole area. The Esophyx instrument works well on patients who don’t have big anatomical problems or need a major reconstruction.
What kind of results have you seen?
Dr. Melvin: The device results are relatively early. It’s only been around for a couple of years, but hundreds of patients have had it done and we know that most patients will get very good to excellent relief of symptoms over the follow-up course. That follow-up is relatively short — still in a period of a year or so — but most patients do quite well and are able to get off medication.
How does the procedure affect patients long-term?
Dr. Melvin: The results of Esophyx are still early so we don’t know what happens five, and ten years down the road, but in at least at one year most patients are able to be off medication and are relatively symptom free.
Is it an outpatient procedure?
Dr. Melvin: Currently it’s an outpatient procedure. It does require a general anesthesia so patients need to be put to sleep for the procedure, but most patients are able to go home later that night or certainly the next day and bounce back pretty quickly.
How high is the risk of esophageal cancer in these patients?
Dr. Melvin: Patients with chronic reflux can have changes in the bottom of their esophagus that can increase their risk of cancer, so anybody with longstanding reflux should get screened to help prevent cancer. The changes can be very early and we can know about them or they can be late; however, if you identify esophageal cancer early, it can be prevented.
How serious of a problem is acid reflux?
Dr. Melvin: About 15 percent of the American population has heartburn that bothers them from time to time. The people that need to have surgery usually have pretty severe symptoms that bother them everyday or keep them awake at night. The other thing reflux can do is cause problems in the esophagus — both changes that can lead to cancer and changes in their lungs. Sometimes we see patients who are even adults who develop asthma or choking as a result of their reflux.