doplasty trans-orifice procedures went into effect Jan. 1, but unfortu-
nately, the number of patients with insurance that covers the proce-
dure is still limited, and paying out of pocket is likely to be too expen-
sive (about $6,500) for some others.
LINX
In this novel minimally invasive surgical approach (marketed by
Torax Medical), you place a ring composed from magnetic titanium
beads around the lower part of the esophagus. When patients swallow,
the beads spread, letting food pass. The magnetic effect then closes the
ring, preventing stomach contents from refluxing back into the esopha-
gus.
Several years of follow-up studies show patients are very responsive
to the procedure and markedly improve in all relevant parameters.
Future studies will focus on whether the ring stays in place or starts
to migrate. In 5-year follow-ups, there have been very few adverse
events. The hope is that the 10-year picture will look just as good.
Another concern is whether the ring will erode over time into the
esophagus — there are a few reports of that happening. Dysphagia is
a common side effect, and it may last a few months.
Some insurers are paying for the FDA-approved procedure, but
many still aren't. At about $20,000, it may be cost-prohibitive for pri-
vate-pay patients.
Medigus Ultrasonic Surgical Endostapler
(MUSE)
Similar to TIF in that it involves transoral fundoplication, the MUSE
system is being performed only on an investigational basis, as Medigus,
its manufacturer, seeks FDA approval. MUSE uses ultrasound and a
stapler at the tip of the scope and is likely to be comparable to TIF in
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