Endoscopic therapies
The approved endoscopic therapies are Stretta, TIF (transoral inci-
sionless fundoplication) and MUSE (Medigus Ultrasonic Surgical
Endostapler). All bring about anatomic changes by means of an endo-
scope.
The obvious advantage is that they require neither surgeons, nor
ORs. But they're appropriate only for certain cases — those in which
patients have mild (Grade A or B) erosive esophagitis, or non-erosive
reflux disease with a clear abnormal pH test on a pH study.
Additionally, they're not appropriate for patients with large (more
than 3 cm) hiatal hernias.
Stretta therapy, which was approved by the FDA in 2000, uses low
levels of non-ablative radiofrequency to modify the structure of the
lower esophageal sphincter, strengthening the muscle and enhancing
its ability to prevent stomach contents from refluxing back into the
esophagus. It's done under conscious sedation and usually takes about
45 minutes.
TIF, approved in 2006, is a non-surgical alternative to Nissen fundo-
plication. Using the TIF procedure, gastroenterologists and surgeons
access the stomach through the mouth with customized instruments
and reconstruct the gastroesophageal valve to reestablish a barrier to
reflux. It's done under general anesthesia, and usually requires a little
more than an hour to do.
MUSE, approved in 2015, is similar to TIF in that it involves transo-
ral fundoplication. It uses ultrasound and a stapler at the tip of the
scope and is likely to be comparable to TIF in the results it produces,
although comparative studies were not done.
All have the potential to be very effective, and the choice may come
down to the preference of both the patient and the practitioner. Of
course, the success of every procedure depends in large part on the
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