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Surgery & Endoscopy for GERD
GERD is a lifelong disease that requires lifelong treatment. The ideal candidate for surgery is the patient who has complete elimination of symptoms with medications but does not want to take them long term. 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. 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:
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