Lasers can help when medicines don’t work
SOME people suffer with reflux no matter what pills they take, while others are unable or unwilling to take anti-reflux medications longterm because of the side-effects.
For such patients, there are surgical and non-invasive procedures. ‘But the majority of patients do not need an operation,’ says surgeon Nicholas Boyle.
The most common procedure is laparoscopic Nissen fundoplication — a keyhole operation where part of the stomach is wrapped around the bottom of the oesophagus to strengthen the valve between the
gullet and the stomach. This is done under general anaesthetic and requires a two or three-day hospital stay. The success rate is around 90 per cent, says Mr Boyle, ‘but 20 to 25 per cent of people will get side-effects, including difficulty with swallowing, vomiting and belching.’
Two alternatives have recently been approved for use in the UK. One, Stretta, is a non-invasive procedure using radiowaves. A catheter is inserted down the throat with four needles attached, which fire radiofrequency energy onto the faulty valve. This damages the tissue and encourages new, stronger tissue to grow, restoring function. It takes around 45 minutes under sedation or general anaesthetic, and patients can go back to work the next day. The valve thickens over time and patients usually improve within a few weeks. Around 90 per cent of patients having Stretta stop PPIs or reduce them significantly.
‘It has an excellent safety record,’ says Dr Chris Fraser, a gastroenterologist at the Royal Infirmary Hospital in Edinburgh who performed the first Stretta procedure in the UK.
With the LINX system, a tiny ring of magnetic beads is implanted around the lower oesophageal sphincter — they’re forced open when food is swallowed, but close so acid cannot travel up. This procedure takes less than an hour under sedation or general anaesthetic. ‘Eighty-five per cent of people have very good control of their symptoms five years after the operation and no longer take antacids,’ says Mr Boyle.