expertise, and the outcome is likely to depend on the provider's skill and
experience. There's a significant learning curve, so patients should go to
a surgeon who does it frequently. It's also labor-intensive, and the length
of time needed to perform the procedure is likely to be a byproduct of
the practitioner's experience — around 90 minutes for a novice, as little
as 45 for a veteran.
Recovery is relatively quick. Patients may develop such short-term
complications as dysphagia, nausea, vomiting and fever, but those
usually resolve within a few days. And most symptoms improve with-
in a few weeks. The majority of patients demonstrate improvement in
quality of life, a significant reduction in PPI use — many are able to
come off PPI treatment — and significant improvement in esophageal
acid exposure. It may be ideal for patients who don't want to take med-
ications on a regular basis, are concerned about the long-term adverse
effects of anti-secretory medications and those who have compliance
issues.
A new CPT Category 1 code (43210) covering esophagogastric fun-
8 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 6
As concerns about proton pump inhibitors (PPIs) continue to
grow, surgical and endoscopic treatments for gastroesophageal
reflux disease are likely to be considered more and more attrac-
tive as alternatives. The long list of conditions associated with
PPIs includes kidney disease, dementia, Clostridium difficile infec-
tion, pneumonia, ischemic heart events (by reducing the effect of
blood thinners) and hip fractures. In most cases, the risks are
relatively modest, but it's understandable that patients with acid
reflux are increasingly driven to seek alternatives.
— Ronnie Fass, MD
ENOUGH TO GIVE YOU HEARTBURN
Serious Side Effects of Proton Pump Inhibitors
