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Traditional Nonsurgical GERD Treatments Not Impressive
Date:1/23/2009

er, it is an underwhelming report, said Dr. Anthony A. Starpoli, a gastroenterologist at Lenox Hill Hospital in New York City, not only because better results were hoped for, but also because both methods are considered obsolete.

"We're talking about older, and not commercially available, techniques that have been supplanted by newer and more effective techniques to perform incisionless surgery," Starpoli said.

The full-thickness plication method was taken off the market last year, and radiofrequency therapy is rarely used in major centers, he noted.

Two new techniques now are used in many medical centers. One, whose brand name is EsophyX, allows surgical repair of the valve without an incision, with instruments inserted through the mouth.

A second technology, the EndoCinch, also uses instruments inserted down the throat, so that tissues can be stitched together to improve function of the valve.

"This EsophyX technique allows for robust remodeling of the anti-reflux barrier," said Starpoli, who uses it himself. Between 70 percent and 80 percent of those undergoing the procedure stop using GERD drugs, which is close to the 90 percent of those having standard surgery, he said.

"I probably do 100 reflux surgeries a year, and probably half to a third would be candidates for this [EsophyX]," said Dr. Reginald Bell, an assistant clinical professor of surgery at the University of Colorado Health Sciences Center in Denver.

That method is less aggressive than standard surgery, and so it is attractive to "a host of patients under medical [drug] therapy to whom current surgical technique does not appeal," Bell said. "Ordinary surgery is more aggressive than they need, their symptoms are not so bad that they need to go to surgery. This is really the first device to do internally what we know we can do externally."

Reports on the EndoCinch technique have been less enthusiastic; several European stud
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