VCU news

By Joe Kuttenkuler

RICHMOND, Va. – Earlier this month, physicians at the VCU Health System became the first in the state to perform a new endoscopic procedure to relieve heartburn caused by reflux. The technique uses an endoscope – a small flexible tube with a camera and light – that is equipped with a new type of suturing device attached to the tip.

"This procedure will have the same impact on endoscopic surgery as laparoscopic techniques had on traditional surgery," said Arun Sanyal, M.D., chairman of the department of gastroenterology in VCU’s School of Medicine.

MCV Hospitals is one of about a dozen centers in the country performing the procedure.

The technique, called an endoluminal gastroplication, involves sewing pleats in the lower portion of the esophagus to prevent stomach acid from backing up into the esophagus, causing heartburn. The pleats are made with a device that works like a tiny sewing machine. The outpatient procedure requires no incisions, making it less invasive than current laparoscopic techniques that have been the standard over the past 10 years.

Esophageal reflux affects about 15 million Americans and is characterized by painful burning symptoms in the chest, difficulty swallowing and nausea. It is generally the result of an abnormal junction between the lower portion of the esophagus – the esophageal sphincter – and the upper part of the stomach. When the sphincter does not function properly, or if there is increased abdominal pressure, stomach acid can back up, or reflux, into the esophagus, resulting in heartburn.

"Unlike the lining of the stomach, the lining of the esophagus was never designed to handle stomach acid," Sanyal said. "Left untreated, reflux can become a very serious problem leading to ulcers and a narrowing of the esophagus. In severe cases, the lining of the esophagus may change increasing the risk for cancer."

Until now, treatment options for reflux included over-the-counter and prescription medications that control stomach acid to relieve the burning symptoms. In severe cases, surgery can be performed laparoscopically to wrap the upper portion of the stomach around the esophagus to elongate and strengthen the esophageal sphincter.

"Our goal with this new technique is to get people feeling better and off their medication, while offering a less-invasive alternative to the current surgical procedure," said Jay Kuemmerle, M.D., associate professor of gastroenterology, who performed the procedure.

According to Kuemmerle, while it is too early to gauge the long-term effectiveness of the procedure, short-term data indicates a large percentage of patients who have had the procedure have been able to stop taking heartburn medication altogether and many more have been able to reduce the amount they take.

Candidates for the procedure include people who require regular medication to control their reflux and are not severely overweight. Patients also must not have experienced a change in the lining of their esophagus as a result of prolonged acid exposure and cannot have had previous esophageal surgery or significant cardio-pulmonary disease.

The VCU Health System has one of the largest academic gastroenterology groups in the United States. The group specializes in the treatment of a variety of digestive disorders in adults and children and sees about 10,000 patients each year.

Patients can obtain more information about the procedure by calling 1-800-281-3887.