How can we deal with the GERD treatment gap?

Triadafilopoulos, George; Azagury, Dan E.

doi:10.1111/nyas.13104

Cited by 11 publications

(4 citation statements)

References 24 publications

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“…As a result, it has been suggested that MSA may be the procedure of choice to minimize the impact of gastrointestinal symptoms after ARS and address the treatment gap between those refractory to medical management yet unwilling to accept the risks of new symptoms after surgery. 10 , 11 To understand the role of MSA in the treatment of GERD, it is imperative to understand its complications. Therefore, in this study, we assessed the incidence, natural course, risk factors, and impact of GBS after MSA.…”

Section: Discussionmentioning

confidence: 99%

Gas-Bloat Syndrome after Magnetic Sphincter Augmentation: Incidence, Natural History, Risk Factors, and Impact on Surgical Outcomes Over Time

Eriksson,

Ayazi,

Zheng

et al. 2023

Journal of the American College of Surgeons

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Background: The notion that gas-bloat syndrome (GBS) after magnetic sphincter augmentation (MSA) is less detrimental, has not been substantiated by data. This study aimed to identify the incidence, natural history, risk factors and impact on outcomes of GBS after MSA. Study Design: Records of patients who underwent MSA at our institution were reviewed. GBS was defined as ≥4 on the gas-bloat-specific item within the GERD-HRQL questionnaire. Preoperative clinical and objective testing data were compared between those with and without GBS at 1-year using univariate followed by multivariable analysis. GBS evolution overtime and its impact on outcome were assessed in those with 1-year and 2-year follow-up. Results: A total of 489 patients underwent MSA. At a mean (SD) follow-up of 12.8 (2.1) months, patient satisfaction was 88.8%, 91.2% discontinued antisecretory medications and 74.2% achieved DeMeester score normalization. At 1-year, 13.3% of patients developed GBS, and had worse GERD-HRQL scores, antisecretory medication use and satisfaction (p<0.0001). DeMeester score normalization was comparable (p=0.856). Independent predictors of GBS were bloating (OR:1.8, p=0.043), GERD-HRQL score >30 (OR:3.0, p=0.0010) and MSA size ≤14 beads (OR:2.5, p=0.004). In a subgroup of 239 patients with 2-year follow-up, 70.4% of patients with GBS at 1-year had resolution by 2-years. The GERD-HRQL total score improved when GBS resolved [11 (7-19) to 7 (4-10), p=0.016]. Patients with persistent GBS at 2-years had worse 2-year GERD-HRQL total scores [20 (5-31) vs 5 (3-12) p=0.019]. Conclusion: Gas-bloat syndrome affects 13.3% of patients at 1-year after MSA and substantially diminishes outcomes. However, GBS resolves spontaneously with quality of life improvement. Patients with preoperative bloating, high GERD-HRQL scores or small MSA devices are at greatest risk of this complication.

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Section: Discussionmentioning

confidence: 99%

Gas-Bloat Syndrome after Magnetic Sphincter Augmentation: Incidence, Natural History, Risk Factors, and Impact on Surgical Outcomes Over Time

Eriksson,

Ayazi,

Zheng

et al. 2023

Journal of the American College of Surgeons

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“…The low number of fundoplications performed annually is likely due to negative connotations on perceived invasiveness of the procedure, reserving surgical referrals as a last resort measure after medical therapy is fully exhausted. This huge disparity between the patient population and surgical volume creates a substantial treatment gap and offers an opportunity for less invasive, endoscopic interventions to address the anatomic basis of the problem and improve outcomes ( 9 , 10 ). Here, we thought to review currently in practice endoscopic interventions aimed at correction of the anatomical basis of GERD.…”

Section: Objectivesmentioning

confidence: 99%

Endoscopic interventions in the management of the gastroesophageal reflux: a narrative review

Akcelik¹,

Miller²,

Bakhos³

et al. 2023

Ann Esophagus

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Objective: The goal of this review is to describe and compare current and historic endoscopic interventions for gastroesophageal reflux disease (GERD). Background: The prevalence of GERD affects a large portion of the population. Nearly half of those treated with conservative medical therapy have refractory symptoms of reflux. Surgery is a durable solution for reflux, however, it is an invasive procedure and classical fundoplication comes with its own share of side effects and complications. In this review, we will discuss the advantages and pitfalls of available endoscopic procedures, and describe medium-term (up to several years) outcomes. Methods: Literature search of the PubMed database, including the years 1999 to 2021 was performed with search terms to reflect the described devices in the review. Individual review of retrieved references was performed for additional sources. Thorough review of societal guidelines was also conducted in preparation of this manuscript. Conclusions: Gastroesophageal reflux is a common problem in the United States and worldwide, and its prevalence continues to increase. Within the last two decades, there have been several new endoscopic modalities introduced for the management of this disease. Here, we present a focused review of endoscopic gastroesophageal reflux interventions, its advantages and pitfalls. Surgeons focusing on the foregut conditions should be aware of these procedures as they may provide a minimally invasive option for the selected group of patients.

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“…Electrical stimulation therapy (EST) is a promising effective method to treat GERD, which may address the need of a large group of GERD patients who suffer from inadequate symptom control of medications ( 15 ) and worry about the potential risks of anti-reflux surgeries (fundoplication) or implanting LES augmentation devices ( 16 – 17 ). Other than passive LES augmentation, EST actively enhances LES muscles to increase the closure pressure of LES without affecting the normal relaxation of LES as the anatomical structure of the gastroesophageal junction is preserved ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

Wirelessly powered deformable electronic stent for noninvasive electrical stimulation of lower esophageal sphincter

et al. 2023

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Electrical stimulation is a promising method to modulate gastrointestinal disorders. However, conventional stimulators need invasive implantation and removal surgeries associated with risks of infection and secondary injuries. Here, we report a battery-free and deformable electronic esophageal stent for wireless stimulation of the lower esophageal sphincter in a noninvasive fashion. The stent consists of an elastic receiver antenna infilled with liquid metal (eutectic gallium-indium), a superelastic nitinol stent skeleton, and a stretchable pulse generator that jointly enables 150% axial elongation and 50% radial compression for transoral delivery through the narrow esophagus. The compliant stent adaptive to the dynamic environment of the esophagus can wirelessly harvest energy through deep tissue. Continuous electrical stimulations delivered by the stent in vivo using pig models significantly increase the pressure of the lower esophageal sphincter. The electronic stent provides a noninvasive platform for bioelectronic therapies in the gastrointestinal tract without the need for open surgery.

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How can we deal with the GERD treatment gap?

Cited by 11 publications

References 24 publications

Gas-Bloat Syndrome after Magnetic Sphincter Augmentation: Incidence, Natural History, Risk Factors, and Impact on Surgical Outcomes Over Time

Gas-Bloat Syndrome after Magnetic Sphincter Augmentation: Incidence, Natural History, Risk Factors, and Impact on Surgical Outcomes Over Time

Endoscopic interventions in the management of the gastroesophageal reflux: a narrative review

Wirelessly powered deformable electronic stent for noninvasive electrical stimulation of lower esophageal sphincter

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