Endoscopic Antireflux Therapies: Are We Near Closing the Treatment Gap in GERD


Endoscopic Antireflux Therapies: Are We Near Closing the Treatment Gap in GERD

Ali Lankarani, MD1, Jose Nieto, DO, FACG2 - Borland Groover Clinic, St. Johns, FL; 2. Borland Groover Clinic, Jacksonville, FL

Introduction: Extra-esophageal symptoms of GERD such as Sore Throat, Laryngopharyngeal Reflux, Non-Cardiac Chest Pain and GERD induced Asthma and aspiration do not respond with the same regularity to PPIs. Regurgitation is quite common and difficult to relieve even with high-dose acid suppression. Until recently there was no minimally invasive alternative until recently. Several endoscopic therapies have been developed and tested in the hope of filling this “treatment gap.”

Methods: Ultrasound Assisted Endoscopic Fundoplasty device or MUSE incorporates a video camera for direct visualization during insertion and staple site selection.

After the staple site selected, the scope will be retroflexed which results in opposition of gastric fundus next the intrabdominal portion of the esophagus 3 cm above the gastroesophageal junction. At this point an alignment pin will be inserted from the distal tip to the shaft of the scope at the area of staple cartridge. This is followed by the insertion of two screws that compress the tissue between the tip and the shaft of scope under continues ultrasound measurements. When proper stapling gap is achieved, 5 standard 4.8mm titanium surgical staples are deployed simultaneously between the stomach and intrabdominal esophagus. During each application, 5 staples simultaneously will be inserted at each location. The scope will be withdrawn from the patient after each staple deployment. The scope will be reinserted after stapling cartridge change to identify the next stapling location. Generally, 3-5 locations will be staples in each patient. This results in deployment of 15 to 25 staples and creation of a 150–180° anterior fundoplication.

Results: Average time per procedure is around 50 minutes. MUSE is a single physician procedure with a steep learning curve. A gastroenterologist with established experience in advanced endoscopic procedures generally is able to achieve 50 minutes, average time per procedure, after appropriate training and two independent procedures. 2/3 of patients post procedure usually can stay off of PPI for long term.

Discussion: Introduction of MUSE as a technically easy and safe platform, to perform Ultrasound Assisted Endoscopic Fundoplasty, sparked the interests again for endoscopic therapy in GERD. Early results showing promising improvement in subjective and objective parameters and potentially this novel technology could play a key role to close the treatment gap in GERD treatment.
Citation: Ali Lankarani, MD; Jose Nieto, DO, FACG. ENDOSCOPIC ANTIREFLUX THERAPIES: ARE WE NEAR CLOSING THE TREATMENT GAP IN GERD. Program No. P1648. ACG 2015 Annual Scientific Meeting Abstracts. Honolulu, HI: American College of Gastroenterology.