Reflux disease, or GERD, is on the rise nationwide! In the past, treatment for reflux consisted of medical therapy with acid-reducing drugs or surgery. The most common medications, PPIs, offer safe and effective short-term relief for heartburn symptoms. Unfortunately, even while on medications for years, many patients are still unable to eat the foods they want or must sleep sitting up to reduce nighttime reflux; additionally, patients frequently become dissatisfied with GERD-related lifestyle adjustments. The media has regularly reported on studies associating complications with long-term use of PPIs—chronic kidney disease, vitamin and mineral deficiencies, interference with Plavix®, intestinal infections, and dementia.

We are pleased to offer a new, exciting treatment option: transoral incisionless fundoplication (TIF). This is a procedure done entirely through the mouth with no incisions. The TIF procedure reconstructs an antireflux valve at the gastroesophageal junction and reduces hiatal hernia, restoring natural anatomical geometry. The procedure generally takes less than one hour and most patients can go home the next day and return to work and most normal activities within a few days.

In a recent study:

• 90% of patients experienced a reduction of troublesome regurgitation
• 88% of patients experienced elimination of all daily atypical symptoms
• And 71% of patients completely stopped taking their PPIs

Most importantly, these positive outcomes remained stable during the follow-up period. Additionally, the TIF procedure has an excellent safety profile. It has been performed on more than 20,000 patients worldwide with a low complication rate of under one half of one percent (0.5%)

Endoscopic mucosal resection is a technique that can be used to remove lesions that are in the GI tract and have not extended outside the walls of the GI lumen. The procedure starts by injecting a substance to thicken the wall underneath the lesion and create a fluid cushion, after which the lesion can be removed safely. This procedure can be done in the esophagus, stomach, small intestine, and large intestine.

Endoscopic submucosal dissection (ESD) was developed in Japan to resect early stage gastrointestinal tumors. This technique can be used for tumors or lesions that are within the walls of the GI lumen but extend into the deepest portion of the wall. It involves the use of special knives to cut away the lesion very precisely, removing the lesion without disrupting the integrity of the gastrointestinal wall. The technique represents a significant advance in therapeutic endoscopy to allow for more accurate pathological assessment and enhanced curability. The major advantages of the technique in comparison with polypectomy and endoscopic mucosal resection (EMR) are the ability to remove deeper lesions all in one piece (en bloc). This procedure can be done in the esophagus, stomach, small intestine, and large intestine.

EFTR is a technique that allows for removal of gastroeintestinal lesions that extend from inside the lumen all the way through the wall. The technique is similar to the resection technique of ESD; however, a hole is made in the gastrointestinal tract during the procedure in order to remove the lesion. At the conclusion of the procedure, it is closed from the inside using small metal clips or endoscopic sutures without the need for surgery. This procedure can be done in the esophagus, stomach, small intestine, and large intestine.

STER is a novel technique in which a tunnel is created between the walls of the gastrointestinal lumen underneath a tumor. An endoscope can then be advanced through the tunnel until it is directly under the tumor. The tumor can then be removed from inside the tunnel, and the entrance to the tunnel can be closed internally without the need to perform and surgery of access through the skin.

POEM is an endoscopic procedure used to treat swallowing disorders, most commonly Achalasia. These disorders are often due to a tightening, or abnormal contraction, of the muscles of the esophagus. In this minimally invasive procedure, the muscles of the lower esophageal wall and the gastroesophageal sphincter (the connection point between the stomach and the esophagus) are opened up to provide less resistance for food to go down into the stomach. This is done by creating a tunnel between the walls of the esophagus, then advancing an endoscope into the tunnel and cutting the muscle layer from inside the tunnel. The tunnel opening is then closed to restore the integrity of the esophagus lumen. POEM has been shown to be associated with faster recovery and less post procedure pain when compared to its surgical alternative, Heller Myotomy. Dr Kahaleh has performed more than 500 POEMs all over the world and has been teaching this procedure all over Latin America where the prevalence of achalasia is very high.

GPOEM is a novel procedure used to treat a condition called gastroparesis. This is when the stomach muscles do not contract properly and it is thus difficult for food to be propelled out of the stomach into the small intestine. A GPOEM works by cutting the muscles of the pylorus, the connection point between the stomach and small intestine, to allow for easier passage of food. The procedure is done by creating a tunnel between the walls of the stomach, then advancing an endoscope into the tunnel and cutting the muscle layer from inside the tunnel. The tunnel opening is then closed to restore the integrity of the stomach lumen. This procedure has been shown, by members of our team, to have an 85% success rate as an alternative to surgery for gastroparesis.

A Zenker's diverticulum, or pharyngeal pouch, is an outpouching of the mucosa of the esophagus just beyond the throat where food first enters. A Zenkers diverticulum can cause inability to eat, recurrent lung infections from aspiration of food that sits in the pouch and eventually comes back up instead of going down into the stomach. A ZPOEM involves opening up the pouch by cutting the septum that separates it from the esophageal lumen, in essence marsupializing the pouch into the esophagus to prevent food from accumulating there. This procedure is extremely successful and is associated with rapid recovery.