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October 9, 2008

No-incision surgery treats acid reflux

People with severe, chronic heartburn that does not respond to medication have a new surgical treatment option at UPMC that does not require any incisions.

Heartburn, which also is known as acid reflux disease, is a condition in which acid from the stomach creeps up into the esophagus and causes a burning sensation in the chest. According to medical literature, as many as 14 million Americans live with acid reflux disease. Complications can lead to esophageal cancer. For patients who do not respond to medication therapy, the only option is surgery. Traditional surgery includes a large open abdominal incision — an operation that takes several hours — and patients ordinarily remain in the hospital for a few days.

The FDA-approved device, known as EsophX, is a tubular device that rides over a standard endoscope. With the patient sedated under general anesthesia, the device is inserted into the patient’s mouth down the esophagus and into the stomach.

EsophX has both an operating and procedural end, enabling surgeons to view the procedure from a tiny fiber optic camera mounted inside the device.

Once the stomach is inflated for surgery, tiny instruments can be deployed to grasp the stomach tissue to begin reconstruction of the valve. The surgeons repeat the procedure until they are satisfied that a one-way valve from the stomach to the esophagus is secured to prevent the backflow of stomach acids.

“Many patients with severe heartburn must take expensive medications, which only treat the symptoms and do not adequately address the underlying problem caused by defective anatomy,” said Blair Jobe, associate professor of surgery in the Division of Thoracic and Foregut Surgery at Pitt’s School of Medicine and director of esophageal research.

“With this novel device, we are now able to permanently correct the patient’s anatomy by creating a tissue barrier against stomach fluid moving into the esophagus,” added Jobe, who also is a member of the first team to perform incisionless heartburn surgery in the United States.

Jobe and his colleagues hope to enroll a wider population of patients in a study of the device to see whether it can be used safely and effectively in patients with a less severe form of heartburn.

For more information about this procedure or the study, contact nurse coordinator Colleen Brown at 412/623-3086.

Filed under: Feature,Volume 41 Issue 4

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