April 18, 2007

Treat GERD with a Snake s Fang

Which GERD treatment is the only one available that not only increases
lower esophageal sphincter pressure and length, but also decreases the
frequency of lower esophageal sphincter relaxations, and corrects the
hiatal hernia? Right. Minimally invasive antireflux surgery. Furthermore it
seems to be preferable for Barrett s esophagus compared to long-term and
expensive acid-suppression therapy. Surgical treatment of GERD seems to be
overshadowing medication due to the reduction in esophageal acid exposure.
Once there are no more nighttime acid breakthroughs long-term relief of
symptoms sets in 96 percent of patients with a restored and normal function
of the antireflux barrier. Minimally invasive antireflux surgery is
effective in Barrett s esophagus, which seems to disappear in some reported
cases of minimally invasive antireflux surgery patients.

A relatively new mechanical Gerd device is the NDO Endoscopic Plication

System. This device came with an overtube and a small caliber endoscope was
used for visual guidance. Retroflexed positioning is possible in order to
view the cardia anteriorly with both endoscope and the plication device.
 GERD animation link: http://www.heartburnhelp.com/dtcf/pages/4 Animations.htm

After opening the jaws of the NDO 1 cm of the squamocolumnar junction is in

reach. A catheter with a corkscrew-type tip is advanced and screwed into
the entire thickness of the gastric wall. The muscularis propria can be
drawn into the span of the jaws. After closing the jaws a large plication
opposing two full thickness portions of the cardia wall is created. A set
of hollow needles just like a snake s fangs is loaded with t anchors and
driven through these tissues. A knotted loop of prolene suture is set with
each T-anchor under tension to appose the two layers of serosa from each
portion of gastric wall. Added benefit of such an endoscopic treatment: the
serosal layers fuse and create a permanent placation that not only tightens
the collar of cardia tissue but also accentuates the angle of His.
Endoscopic gastroplication is a viable alternative to laparoscopic
fundoplication in selected patients. Nevertheless, approximately one
quarter of patients will have no improvement, which is much more than those
undergoing laparoscopic fundoplication.

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