Incisionless Heartburn Surgery Now Available At UPMC

Main Category: Acid Reflux / GERD
Also Included In: GastroIntestinal / Gastroenterology
Article Date: 17 Sep 2008 - 15:00 PDT

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People with severe, chronic heartburn that does not respond to medication now 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 and complications can lead to esophageal cancer. For patients who do not respond to medication therapy, their only option is surgery. Traditional surgery includes a large open abdominal incision-an operation that takes several hours-and patients must 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. 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," said Blair Jobe, M.D., F.A.C.S., associate professor of surgery, division of thoracic and foregut surgery, University of Pittsburgh School of Medicine, and director of esophageal research, member of the first team to perform incisionless heartburn surgery in the United States.

"This is an approximately one-hour procedure with a one-night hospital stay, which translates to shorter recovery time and fewer complications for the patient,"

Dr. Jobe and colleagues published a landmark study in a recent issue of Annals of Surgery, proving the anatomic basis for esophageal reconstruction and successfully demonstrating that this technique can be used safely and effectively by securing the tissue that lies between the stomach and esophagus.

"This technology supports the ongoing trend towards minimally invasive surgery options for patients," said James D. Luketich, M.D., F.A.C.S., the Henry T. Bahnson professor of cardiothoracic surgery, chief, division of thoracic and foregut surgery at the University of Pittsburgh School of Medicine, and director of the Heart, Lung and Esophageal Surgery Institute at UPMC. As a national leader in the field of minimally invasive thoracic surgery, our patients benefit from a wide menu of comprehensive treatment options. It is our hope that this incisionless approach can someday be used to treat other medical conditions of the esophagus," he added.

Among the team of surgeons from the UPMC Heart, Lung and Esophageal Surgery Institute who perform incisionless heartburn surgery are Manisha Shende, M.D., assistant professor of surgery and Matthew Schuchert, M.D., associate professor of surgery.

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

To view a photo of Dr. Jobe holding the EsophX device, please click here.

To view a photo of Drs. Shende and Jobe demonstrating the incisionless anti-reflux procedure with the EsophX device, click here. Dr. Shende is working the operating end and Dr. Jobe is working the procedural end.

University of Pittsburgh Medical Center