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Are New Surgical Options for GERD Worth It?

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.

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