Though endoscopic therapies are less expensive to perform, payers
are faced with the conundrum of paying for the care of patients in
which the interventions might fail, according to Dr. Schwaitzberg.
"Payers must decide if paying once for a more significant laparoscop-
ic procedure makes more sense than paying for a smaller endoscopic
intervention that might not work as well," he says.
Concerns persist about how well surgical interventions provide
durable and long-lasting esophageal protection. "Surgical treatment
options will not beat proton pump inhibitors for controlling heartburn
or healing esophagitis," says Dr. Kahrilas. "Proton pump inhibitors
aren't effective in preventing regurgitation, which these surgical and
endoscopic interventions are designed to limit the reflux.
"For it to reach mouth, a large volume would have to distend the
esophagus," he explains. "Preventing that is an important goal, and
surgical intervention appears to work well, but data supporting it is
somewhat limited."
OSM
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