Surgery & Endoscopy
SURGICAL TREATMENT of GERD
GERD is a lifelong disease that requires lifelong
The ideal candidate for surgery is the patient who has complete
elimination of symptoms with medications but does not want to take them long
With PPIs availability and
elimination of acid reflux, surgery for GERD may be more appropriate for “volume refluxers”, i.e., those
with regurgitation with or without supraesophageal complications.
Follow-up of a randomized controlled trial shows that 62%
of patients who have undergone antireflux surgery will go back on antireflux
medications (JAMA 2001, 285:2331-2338).
A recent modification of a longstanding open-procedure
known as the "Nissen's
Fundoplication" has been developed. This is called the laparoscopic Nissen's
Fundoplication, and involves wrapping the stomach around the esophagus. This
surgery may cause temporary dysphagia and a chronic condition called gas-bloat
syndrome. Esophageal manometry is recommended before surgery to make
sure the patient is not suffering from "lead pipe esophagus".
The treatment for reflux laryngitis and chronic
cough is high dose proton pump inhibitors (PPI)for several months. Patients
with intractable reflux induced cough may benefit from surgery.
ENDOSCOPIC TREATMENT of GERD
In a recent invited editorial published in the June 2002 issue of Current
Gastroentrology Reports, Dr. JP Galmiche from France writes: “Endoscopic
therapy for GERD is an attractive concept that needs to be performed in reference
centers and in the context of well designed studies comparing different PPI
strategies, eg, continuous or intermittent and on-demand PPI therapy.
Relevant outcome measures, including economic endpoints and long-term assessment,
are necessary before these novel approaches can be proposed in routine practice”.
Finally, do we need an alternative for uncomplicated
GERD now that medical therapy is becoming better and cheaper? Do we
burn any bridges by endoscopic therapy if a patient eventually needs surgery?
ENDOSCOPIC TECHNIQUES in TREATMENT of GERD
INDICATIONS for ENDOSCOPIC
TREATMENT of GERD
Non-Surgical candidates who suffer from the following conditions: