focused on supporting the function of the lower esophageal sphincter
without having to violate the peritoneal cavity. However, none of the
solutions provided a safe and durable (more than 6 months) anti-
reflux barrier in pathological refluxers, according to Dr. Park. For
example, he says, endoscopic radiofrequency ablation impacts reflux
scores more than it affects esophageal acid exposure.
Surgeons who opt for endoluminal plication techniques employ an
endoscope and proprietary device to reconstruct the angle of His,
which is the normally acute angle between the abdominal esophagus
and the fundus of the stomach at the esophagogastric junction that's a
key component of the body's natural anti-reflux barrier. A growing
number of studies authored by champions of the treatment technolo-
gies support the efficiency of these approaches, but their market pen-
etrations have so far been lacking, perhaps because physicians remain
unconvinced that they provide durable esophageal protection. The
endoluminal approaches don't involve laparoscopy or laparotomy, but
they're not without risk of various serious complications, says Dr.
Park.
He's keeping a close watch on a solution involving the use of mag-
netic rings implanted laparoscopically to augment the function of the
lower esophageal sphincter. The magnetic rings have shown promise
in being tolerated after implantation and are distinct from other
devices in that they can limit esophageal acid exposure by truly aug-
menting the function of the natural lower esophageal sphincter. If the
rings prove durable and work as designed, they may add to the treat-
ment armamentarium for refractory reflux patients.
Of course, the potential advances in GERD treatments don't stand a
chance of becoming mainstream if facilities and surgeons can't get
reimbursed for performing them. Dr. Park laments the difficulty he
has in getting third-party payers to reimburse for the use of the alter-
9 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 • N O V E M B E R 2 0 1 6
