the stomach under ultrasound guidance. Dr. Kahrilas says the device
provides a strong fixation and the ultrasound imaging acts as a safety
mechanism that lets surgeons know that the folds of tissue they grab
with the endoscopic stapler do not contain unseen blood vessels or
the crural diaphragm.
Slow growth
Both laparoscopic magnetic sphincter augmentation and fundoplica-
tion can be performed safely in the surgery center setting as long as
surgeons have the necessary laparoscopic skills to work safely and
effectively around the esophagus and diaphragm, notes Dr.
Schwaitzberg. Surgeons must also be more aggressive in managing
the post-op diet of patients to ensure the durability of the surgical
interventions.
Endoscopic treatments are largely effective in patients with mild to
moderate disease, but require slightly different approaches to manag-
ing the post-op diet of patients and are not generally indicated for
patients with a large hiatal hernia, according to Dr. Schwaitzberg.
"You have to be much more aggressive in limiting or altering the foods
patients might ordinarily eat," he explains.
The more minimally invasive endoscopic procedures are less inva-
sive and are associated with faster recoveries and fewer adverse
events than laparoscopic techniques. Limited clinical data suggest
endoscopic treatments provide durable solutions to reflux disease,
but the procedures have been trialed primarily in patients with mini-
mal esophageal inflammation and small hiatus hernias, according to
recent research (osmag.net/cJA9Td).
The report says endoscopic interventions have been proven to
reduce esophageal acid exposure, but don't solve the condition, which
over the time can cause Barrett's esophagus and esophageal adenocar-
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