The EsophyX procedure treats GERD transorally (through the mouth). It improves reflux symptoms more effectively than anti-acid medications, and enables many patients to stop taking anti-acid medications altogether. No incisions are required and recovery is even faster than the laparoscopic fundoplication. The EsophyX procedure reinforces the gastroesophageal junction by folding (plicating) the upper portion of the stomach (the fundus) around the gastroesophageal junction for about 270 degrees and securing it in place by special fasteners. It is based on the same principles that have been shown to be effective in the Nissen fundoplication. It is FDA approved and has been in use since 2006. We began performing this procedure in November 2008. As of May 2010 we have performed over 80 procedures, representing one of the largest experiences in the United States.

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Benefits over Medical Therapy:
The EsophyX procedure works better than medical therapy alone (e.g. Prilosec, Nexium, Protonix, etc.) in allowing patients to eat spicy, acidic, or other reflux-causing foods. EsophyX also enables more patients to exercise and sleep without reflux symptoms. Many patients are able to stop taking anti-acid medications altogether - which is important as Proton Pump Inhibitors (Nexium, Protonix, Prevacid, etc.) have been linked to osteoporosis. (Calcium is best absorbed when it has stomach acid around).

EsophyX in Comparison to Laparoscopic Fundoplication:
Even though a laparoscopic fundoplication offers a fairly rapid return to work (2-4 weeks) and physical activity (6 weeks), the EsophyX procedure offers a faster return to normal activity (1 week, often less), fewer operative risks and less postoperative pain. (Both procedures require a similar diet for the first weeks afterwards.) Symptoms of bloating, gas, diarrhea, and discomfort swallowing that occurs in about 5% of patients having a laparoscopic fundoplication have not been seen with the EsophyX TIF procedure. The EsophyX procedure is not designed for patients with moderate to large hiatal hernias, however; and its overall durability is probably less than that for a laparoscopic fundoplication. However, the Esophyx can be redone or a laparoscopic fundoplication can be performed if it stops working.

Results of the EsophyX TIF Procedure:
The TIF procedure was initially evaluated in Europe by Prof. Guy-Bernard Cadiere in Brussels and NIcole Bouvy in Maastrich, Netherlands. Both of their series demonstrated that over 75% of patients were able to stop using acid-suppressive medication a a result of the procedure. A two year follow-up published by Professor Cadiere reported that 79% of patients experienced complete cure or remission of their GERD symptoms. In May 2010 we completed a review of our first 37 patients at a median of 6 months after the procedure. We found that 82% were off of acid-suppressive medication with significant improvement in their quality of life (measured by standardized questionnaires). Additionally, reflux testing demonstrated that 73% of patients had a significant improvement in the amount of acid reflux present, which is better than other reported series.

Is EsophyX for Me?
Patients with GastroEsophageal Reflux or Laryngeal Reflux may wish to consider the EsophyX procedure if:
-increasing doses of medication are needed; or
-patients are having to switch medications because one is not working; or
-heartburn, reflux, or other GERD symptoms persist despite taking medication; or
-upper airway or laryngeal symptoms are due to non-acid reflux; or
-the patient is already at high risk for osteoporosis,
In order to be a candidate for Esophyx, patients must have gastroesophageal reflux disease and a reducible hiatal hernia of 2 cm or less. We often confirm that a patient has GERD by a pH or impedance test. We assess hiatal hernia by a upper GI X-ray series and/or upper GI endoscopy. Patients with significant obesity (BMI >35), Barrett's esophagus, or signficant narrowing in the upper esophagus, are generally not candidates for the procedure.

Details of the Esophyx Procedure:
The Esophyx procedure is performed under a general anesthetic in an operating room or GI lab setting. The procedure takes 1-2 hours. A flexible endoscope is introduced through the mouth into the stomach to visualize the operation. The EsophyX device slips over the endoscope and into the lower esophagus and stomach. The EsophyX device then pulls down on the junction of the esophagus and stomach while a paddle pushes the stomach wall against the esophagus. This recreates the flap-valve mechanism and gets rid of the hiatal hernia. Once tissues are properly positioned, the surgeon places H-fasteners in between the esophagus and stomach wall using the EsophyX device. These H-fasteners function like sutures to hold the valve mechanism in place.
Following the procedure patients are typically observed overnight and go home the following day. They are started on liquids the day of the procedure and follow a graduated diet plan for the next month. Pain in the upper abdomen, throat, or chest is typically short-lived. Nausea, though not frequent, is treated aggressively with anti-nausea medications to prevent disruption of the repair.
Many patients return to desk work or light duty within a week. Stairs, walking, and mild aerobic activity are permitted immediately. Strenuos physical activity including heavy lifting is limited for 4-6 weeks to allow the issues to adequately bond to one another.
Patients generally stop taking anti-acid medication and notice that their heartburn and reflux is gone. They can sleep better without having to be upright, and can enjoy acidic foods more often.
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