Medication of Diseases News - Part 79

Endoscopic ‘antireflux’ procedures: THE STRETTA PROCEDURE (Part 1)

The Stretta procedure (Curon Medical Inc, USA) induces changes (inflammation and fibrosis) in the LES and surrounding tissue using radiofrequency energy delivered via a probe fitted with four 22G nickel-titanium needle electrodes protruding radially into the lower esophageal wall from sheaths around a centering balloon, while the mucosa is cooled with water irrigation, using a temperature-controlled generator system. The probe is passed blindly through the mouth after the distance from the incisors to the squamocolumnar junction has been measured at endoscopy.

Endoscopic ‘antireflux’ procedures: COMMON METHODOLOGICAL CONCERNS

This is especially true for early work on new technologies, for which the mechanism of the anticipated reduction in symptoms has not been well worked out. For GERD, such objective end points exist and are readily available (24 h esophageal pH monitoring and LES manometry). It is therefore disappointing that despite a nonrandomized and nonblinded study design being chosen for many of the reported studies, subjective end points were typically selected as the primary outcomes and objective end points were either relegated to secondary outcomes or not reported at all.

Endoscopic ‘antireflux’ procedures (Part 3)

health care systemWithin the Canadian health care system setting, laparoscopic Nissen fundoplication appears to be less costly than medical therapy when PPI use of more than three years is anticipated. Given the marked costs of long-term medical therapy and the morbidity in a small proportion of patients who undergo surgery for reflux, there has been growing interest in a number of outpatient endoscopic options for treating reflux. There are three broad categories of endoscopic antireflux procedures:

Endoscopic ‘antireflux’ procedures (Part 2)

Alternatives to the costs and inconvenience of long-term acid suppression therapy in those with erosive esophagitis include laparoscopic or open fundoplication. A review of the fundoplication literature is not the purpose of the present paper. However, a brief commentary is necessary to provide a frame of reference against which to compare the new technologies being discussed. Fundoplication is reported to improve quality of life and possibly Barrett’s esophagus and extraesophageal manifestations of reflux.

Endoscopic ‘antireflux’ procedures (Part 1)

Gastroesophageal reflux diseaseGastroesophageal reflux disease (GERD) affects 20% of adults in the United States on a weekly basis and has a significant effect on the quality of life for North Americans . The pathophysiology involves an increase in transient lower esophageal sphincter relaxations, decreased lower esophageal sphincter (LES) pressure (intrinsic weakness and pharmacological weakness), mechanical factors such as hiatus hernia and obesity. Each component contributes to a different extent in any given patient.

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