restricting reflux, which is the Achilles' heel of proton pump inhibitors,"
says Peter Kahrilas, MD, a professor of gastroenterology and hepatol-
ogy at Northwestern University of Feinberg School of Medicine in
Chicago, Ill. "Patients who have the device implanted do quite well.
They're able to get off proton pump inhibitors and have shown marked
reductions in regurgitation and heartburn."
The procedure came under criticism over concerns of the device
eroding into the esophagus. That issue was primarily associated with
a previous generation that had smaller magnetic rings and has since
been taken off the market; the manufacturer of the latest magnetic
sphincter augmentation device is optimistic that the issue of erosion
into the esophagus has been lessened, according to Steven
Schwaitzberg, MD, professor and chairman of the department of sur-
gery at the University of Buffalo Jacobs School of Medicine and
Biomedical Sciences. Dr. Schwaitzberg, who's also the chair of the
FDA's GI panel, says this treatment option has received its own CPT
code and there has been movement among large commercial payers
to pay for the procedure.
• Transoral fundoplication (TIF). This endoluminal plication tech-
nique employs an endoscope and proprietary device to reconstruct
the angle of His — the normally acute angle between the abdominal
esophagus and the fundus of the stomach at the esophagogastric junc-
tion, which is a key component of the natural anti-reflux barrier.
"You're constructing something that looks like laparoscopic Nissen
fundoplication using a tool that fits around an endoscope," says Dr.
Kahrilas. He was involved in a study that tested the ability of the
device to prevent problematic regurgitation, which was the primary
endpoint to achieve therapeutic efficacy. The 6-month trial had a sta-
tistically significant result, but was limited by its duration.
Dr. Schwaitzberg says the TIF procedure has enjoyed a recent resur-
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