A national leader in incision-free surgery performed through natural orifices, the Center for Scarless Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center is now offering patients with severe, chronic acid reflux disease a unique incision-free procedure called TIF, or transoral incisionless fundoplication.

An estimated 30 million Americans are diagnosed with chronic GERD (gastroesophageal reflux disease), painful heartburn caused when stomach acid breaks through what is supposed to be a one-way valve -- the lower esophageal sphincter (LES) -- and reverses into the esophagus. GERD increases risk of cancer of the esophagus, and can cause damage due to inhalation of stomach acid. While most patients are prescribed a daily medication, it is sometimes ineffective. In addition, new research indicates that continued drug therapy may cause calcium depletion, contributing to osteoporosis.

"Drug therapy, when it works, is simply masking an underlying anatomic defect. The TIF procedure corrects the source of the problem by repairing the faulty lower esophageal sphincter in order to keep stomach acid where it belongs," says Dr. Marc Bessler, director of laparoscopic surgery and director of the Center for Obesity Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, and assistant professor of surgery at Columbia University College of Physicians and Surgeons.

The procedure is performed under general anesthesia and takes less than an hour. The clinician inserts a specially-designed device through the patient's mouth and into the stomach, just below the gastroesophageal junction, where tissue is molded to create a new valve.

"In most cases, the result is an elimination of reflux, with research showing that 80 percent of patients treated no longer need to take daily medications," says Dr. Peter D. Stevens, director of endoscopy, director of interventional endoscopy and medical director of the scarless surgery program at NewYork-Presbyterian Hospital/Columbia University Medical Center, and associate professor of medicine at Columbia University College of Physicians and Surgeons.

"Because there are no incisions, the TIF procedure is more comfortable for the patient than the traditional open or laparoscopic approach, with a shorter hospital stay, improved recovery, and reduced risk of complications compared with open or laparoscopic surgery," adds Dr. Stevens."Unlike prior endoscopic treatments for reflux, the molding of the flap valve that holds back acid is expected to be much more robust and effective."

The procedure makes use of the FDA-approved EsophyX®, a surgical device by EndoGastric Solutions (EGS) of Redmond, Wash., and Redwood City, Calif. The company also makes the StomaphyX® NOS surgical device, which is used for a variety of stomach surgeries, including an incision-free weight-loss procedure.

Other Incision-Free GI Procedures at NewYork-Presbyterian/Columbia

NewYork-Presbyterian/Columbia offers patients two other incision-free gastrointestinal procedures:

-- NOTES. In natural-orifice translumenal endoscopic surgery (or NOTES), the surgeon makes an internal incision through the wall of an organ or internal cavity, such as the stomach, or behind the uterus (retro-uterine) to access internal organs, including the gallbladder and appendix. The approach provides a better cosmetic outcome than traditional minimally invasive procedures. Recovery time is similar to other abdominal minimal-access operations. NewYork-Presbyterian/Columbia's Dr. Marc Bessler was one of the first in the nation to perform the surgery, which is currently offered as part of an ongoing clinical research trial.

-- TOGA. Offered as part of an ongoing multicenter TOGA Pivotal Trial at NewYork-Presbyterian Hospital/Columbia University Medical Center, the TOGA Procedure (for"transoral gastroplasty"), like other obesity procedures, is designed to alter the patient's stomach anatomy to give them a feeling of fullness after a small meal. The difference is that TOGA is performed under direct endoscopic visualization with specialized instruments passed into the stomach through the mouth without any incisions.

NewYork-Presbyterian Hospital/Columbia University Medical Center

NewYork-Presbyterian Hospital/Columbia University Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and its academic partner, Columbia University College of Physicians and Surgeons. NewYork-Presbyterian/Columbia provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian, which is among U.S.News & World Report's top 10 hospitals nationally, also comprises NewYork-Presbyterian Hospital/Weill Cornell Medical Center and its academic affiliate, Weill Cornell Medical College. For more information, visit http://www.nyp.org.

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