Heartburn Support

Author

Plicator

Derek F

2005-12-04, 10:53 am

Recently read a UK news article about a new treatment for heartburn. As it
has been around in America for longer does anyone have experience of it?
http://www.ndosurgical.com/index.html

Derek.

Howard McCollister

2005-12-04, 10:53 am

"Derek F" <lordpilrig@NOXbtinternet.com> wrote in message
news:dmv4a7$l8f$1@nwrdmz02.dmz.ncs.ea.ibs-infra.bt.com...
> Recently read a UK news article about a new treatment for heartburn. As it
> has been around in America for longer does anyone have experience of it?
> http://www.ndosurgical.com/index.html
>

Bard had/has the Endo-Cinch for years in the US. It plicates the mucosa.
It's a miserable failure. The Plicator is different in that it's a full
thickness sewing machine. It's way, way too early to tell it it's going to
be useful, or have any realistic comparison to the gold standard - gastric
fundoplication.

The main reason one might want to avoid a Nissen is the side effect of
gas/bloat. Be aware that there is no real good way to repair a defective LES
without causing some of that. All of the lesser technologies like EndoCinch,
Enteryx, GateKeeper, Stretta have been nice in that they have few or *no*
such side effects, but the downside is that they just don't work.

Hard to tell at this early stage, but my long experience in this arena makes
me highly suspicious that the Plicator will end up being just another
half-measure that will ultimately fall by the wayside and land in the same
heap as the above technologies. Time will tell.

HMc

Mr Wal

2005-12-12, 10:56 am

Hi there Howard,

I have been a reader of this newsgroup for a number of years, but never
actually said anything

I thank you for your insights and comments
and observations.

I have a question re your comments below:

Howard McCollister <nospam@nospam.net> wrote:
> The main reason one might want to avoid a Nissen is the side effect of
> gas/bloat. Be aware that there is no real good way to repair a defective LES
> without causing some of that. All of the lesser technologies like EndoCinch,
> Enteryx, GateKeeper, Stretta have been nice in that they have few or *no*
> such side effects, but the downside is that they just don't work.

So your opinion is that the Stretta procedure is not useful for GERD? My
reading had said that it worked for a while then needed to be re-done, but
I'm interested in your comment above. My gastro also thought that stretta
was not a particularly good solution to GERD as well, but it was about
3 years ago when I talked to him about it.

At the moment 20 mg of Somac once every 2 days seems to placate my GERD
symptoms. As a result I dont think that I particularly want to do any
surgery. Do you think that this is a reasonable long term choice? I have
been on Somac for probably around 6 years or so now, possibly a bit longer.

Regards
Chris.

Howard McCollister

2005-12-12, 5:55 pm

"Mr Wal" <superwally@gmail.com> wrote in message
news:439d6f32$0$18197$afc38c87@news.optusnet.com.au...
> Hi there Howard,
>
> I have been a reader of this newsgroup for a number of years, but never
> actually said anything

I thank you for your insights and comments
> and observations.
>
> I have a question re your comments below:
>
> Howard McCollister <nospam@nospam.net> wrote:
>
> So your opinion is that the Stretta procedure is not useful for GERD? My
> reading had said that it worked for a while then needed to be re-done, but
> I'm interested in your comment above. My gastro also thought that stretta
> was not a particularly good solution to GERD as well, but it was about
> 3 years ago when I talked to him about it.
>
> At the moment 20 mg of Somac once every 2 days seems to placate my GERD
> symptoms. As a result I dont think that I particularly want to do any
> surgery. Do you think that this is a reasonable long term choice? I have
> been on Somac for probably around 6 years or so now, possibly a bit
> longer.
>

Of all of the alternate technologies, the Stretta procedure is probably the
most useful, but its success rate is relatively low - about 70% of GERD
patients who have a Stretta will be off of their meds in 1 year. Now, I
suspect one of the reasons for the low success rate is that Stretta has been
applied to all GERD patients, whereas I believe that there is only a subset
for whom it is optimally applicable. I have done many, many Strettas. I
believe that the best patients are those whose GERD is related to transient
inappropriate LES relaxation, but have a normal to low-normal resting LES
pressure. Another category where I think the Stretta may work fairly well
are those GERD patients whose primary cause is a low resting LES pressure,
but not TOO low. Any obvious laxity of the LES on EGD, or resting LES
pressures less than about 15 mmHg will have predictably less success IMHO.

In those two categories, I will offer Stretta as an option, and it's not a
bad thing to try. It's not painful, has very few (if any) side effects, is
very safe, and is an outpatient procedure with virtually no time off work.
And, if it doesn't work, it does not impair the possibility of a Nissen
later on.

HMc

louise

2005-12-17, 10:54 am

Howard McCollister wrote:
> "Mr Wal" <superwally@gmail.com> wrote in message
> news:439d6f32$0$18197$afc38c87@news.optusnet.com.au...
>
>
>
> Of all of the alternate technologies, the Stretta procedure is probably the
> most useful, but its success rate is relatively low - about 70% of GERD
> patients who have a Stretta will be off of their meds in 1 year. Now, I
> suspect one of the reasons for the low success rate is that Stretta has been
> applied to all GERD patients, whereas I believe that there is only a subset
> for whom it is optimally applicable. I have done many, many Strettas. I
> believe that the best patients are those whose GERD is related to transient
> inappropriate LES relaxation, but have a normal to low-normal resting LES
> pressure. Another category where I think the Stretta may work fairly well
> are those GERD patients whose primary cause is a low resting LES pressure,
> but not TOO low. Any obvious laxity of the LES on EGD, or resting LES
> pressures less than about 15 mmHg will have predictably less success IMHO.
>
> In those two categories, I will offer Stretta as an option, and it's not a
> bad thing to try. It's not painful, has very few (if any) side effects, is
> very safe, and is an outpatient procedure with virtually no time off work.
> And, if it doesn't work, it does not impair the possibility of a Nissen
> later on.
>
> HMc
>
>
>
Would you recommend a stretta rather than have someone on
something like Prevacid 30mg/day with occasional weeks of
60mg/day to calm things down? In other words, is the
Stretta preferable to the proton pump inhibitors?

TIA

Louise

Howard McCollister

2005-12-17, 10:54 am

"louise" <louise@nospam.com> wrote in message
news:hUQof.2538$Ed.212@news-wrt-01.rdc-nyc.rr.com...

> Would you recommend a stretta rather than have someone on something like
> Prevacid 30mg/day with occasional weeks of 60mg/day to calm things down?
> In other words, is the Stretta preferable to the proton pump inhibitors?
>

If there is no damage to to lower esophagus as seen on EGD - stricture,
erosive esophagitis, Barrett's esophagus - and the symptoms of GERD are
being controlled with medication and lifestyle changes *to the patient's
satisfaction*, then symptomatic treatment only, with PPIs or whatever, is
entirely appropriate.

In the absence of that demonstrable esophageal pathology, the question of
Stretta being preferable to medication is one only the patient can answer.

HMc