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By Michael Lasalandra, BIDMC Correspondent

Doctors at Beth Israel Deaconess Medical Center are now offering a new minimally invasive surgical procedure for patients with gastroesophageal reflux disease (GERD) who continue to have chronic symptoms even after trying all the medical management therapies used for treatment of the condition.

GERD occurs when food or liquid in the stomach flows back into the esophagus, causing irritation, heartburn and other symptoms. Most patients first try dietary and lifestyle changes or one of a number of medications such as antacids or proton pump inhibitors.

(Credit: iStockphoto)

(Credit: iStockphoto)

When these don’t work, the traditional option has been an operation called fundoplication, where the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle, strengthening the valve between the esophagus and stomach, stopping the acid from backing up into the esophagus.

However, the operation, which can be performed in a minimally invasive laparoscopic fashion, is associated with a number of side effects and the fix can wear out over time, according to Dr. Michael Kent, Director of Minimally Invasive Thoracic Surgery at BIDMC, who has performed them for many years. Dr. Jon Critchlow, another surgeon at BIDMC, also has performed the operation for years.

Both will soon begin offering the new alternative, which is called LINX. It was approved by the FDA last year after being in clinical trials since 2007. The LINX device is a titanium ring of magnetic beads. It is placed around the lower end of the esophagus to strengthen the sphincter or muscle ring. It is designed to prevent acid and other stomach contents from backing up, but at the same time allows food and liquids to enter the stomach.

“It has a very good safety profile,” says Dr. Kent. “It is a quick operation and and it is easily removable. It is a very good minimally invasive alternative for patients who are not satisfied with medications and don’t want to go through with fundoplication.”

In the LINX system, the titanium beads, each with a magnetic core, are connected together with independent titanium wires to form a ring. It is implanted at the lower esophageal sphincter (LES), a circular band of muscle that closes the end of the esophagus and prevents the backward flow of contents from the stomach.

The force of the magnetic beads provides additional strength to keep a weak sphincter closed. Upon swallowing, the magnetic force between the beads is overcome by the higher pressures of swallowing forces, and the device expands to accommodate a normal swallow of food or liquid. Once the food passes though the sphincter, the device returns to its resting state.

The two types of surgeries are each able to be done laparoscopically and are both covered by insurance.

Dr. Kent says the new procedure may be better in some cases because fundoplication sometimes fails over time, where LINX is designed to be permanent. If fundoplication fails, it is hard to do it over again, he says.

Both surgeries can be associated with side effects, however, including difficulty swallowing. In addition, those with LINX may not undergo MRI scans because the beads in the LINX system are magnetic.

“We’re hoping it provides long term control of GERD,” he says.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted: March 2013


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