The EndoCinch endoluminal gastroplication surgery used to be a treatment option for gastroeophageal reflux disease (GERD). However, due to disappointing long-term success rates, this surgery is no longer used.
Today, other treatment options are available. These include prescription and over-the-counter (OTC) drugs along with surgical and nonsurgical procedures.
Gastroesophageal reflux disease (GERD) is the chronic form of acid reflux. This condition occurs when the contents of the stomach, including stomach acid, leak back into the esophagus.
Normally, stomach contents are kept in the stomach by a group of muscles called the lower esophageal sphincter (LES). When these muscles aren’t functioning properly, digestive juices and stomach content can move back up into the esophagus.
When muscles in the LES aren’t functioning properly and digestive juices and stomach acid move back up into the esophagus it may cause symptoms that include:
- burning sensation in the chest, or heartburn
- sore throat
- sensation of a lump in the throat
- difficulty swallowing
- feeling of excessive fullness
Over time, GERD can damage the lining of the esophagus and lead to serious complications that include:
- severe chest pain
- narrowing of the esophagus
- bleeding in the esophagus
People with GERD will need continuous, long-term treatment. There are prescription and OTC drugs available.
Prescription medication, like proton-pump inhibitors (PPIs) and H-2 blockers include:
- dexlansoprazole (Dexilant, Kapidex)
- pantoprazole sodium (Protonix)
- lansoprazole (Prevacid)
OTC medications include:
- esomeprazole magnesium (Nexium)
- omeprazole (Prilosec)
- lansoprazole (Prevacid)
- cimetidine (Tagamet)
- famotidine (Pepcid)
- ranitidine (Zantac)
Also, Barrett's esophagus, a serious complication linked to an increased risk of esophageal cancer is usually treated with OTC antacids. If these don’t work, your doctor may recommend other medications or surgery to help strengthen the LES.
Most people with GERD don’t have fully functional LES muscles. Surgical and nonsurgical procedures are used to help strengthen or reinforce these muscles.
A surgery known as EndoCinch endoluminal gastroplication (ELGP) was a treatment option for GERD. ELGP was an outpatient procedure considered minimally invasive because it didn’t require any incisions into the abdomen.
ELGP combined endoscopy with a suturing, or stitch, system to reinforce the LES. An experienced endoscopist typically performed this procedure.
ELGP was performed under sedation and took less than two hours. It involved the following steps:
- An endoscopist inserted a tube down the throat to the muscles that connect the throat to the stomach.
- Using an endoscope, the endoscopist examined the inside of the esophagus and confirmed earlier findings.
- The esophagus was dilated, or expanded.
- The doctor used suction to capture a fold of tissue of the stomach.
- Using the EndoCinch device, which resembled a miniature sewing machine, the doctor stitched the fold of tissue just below the LES. Most people required two or more stitches to strengthen the LES and prevent backup of stomach acids into the esophagus.
- The device and tube were removed.
Most people who had this procedure returned home the same day and were able to resume normal activities within 24 hours.
EndoCinch was thought to be a good option for people who don’t respond well to drugs or aren’t good candidates for Nissen fundoplication or other surgeries.
However, the procedure is no longer recommended for use in clinical practice. The manufacturer, Bard, has also discontinued the EndoCinch Suturing System.
There are now other treatments for GERD that are considered more effective than the EndoCinch procedure. These include:
Today the standard surgery to treat GERD is called Nissen fundoplication. This is a laparoscopic procedure that involves making three or four small incisions in the stomach. Surgical instruments are inserted through the incisions, including a flexible tube with a small camera. Once the surgeon is able to see the area they will strengthen the LES by wrapping the upper stomach around it.
The Stretta procedure involves inserting a tube down the throat and inflating a balloon to the size of the patient’s LES. Radio waves are then sent down the tube to provide a tightening effect to the LES. The tube also releases water to help prevent any heat damage inside the body.
The procedure takes about 60 minutes and requires sedation.
LINX reflux management system
The FDA approved LINX in March 2012 as a device for the treatment for GERD. It is a permanent implant that consists of a small, flexible band of beads. Each bead contains a magnet.
The band is placed around the outside of the esophagus. The magnetic attraction of the beads keeps the sphincter closed to prevent stomach contents from moving back into the esophagus. The beads temporarily separate when swallowing to allow food to pass through normally.