Rapid City Surgeon Offers Minimally Invasive Option for GERD
By: Alex Strauss
Magnets are playing an increasingly important role in several different areas of medicine. From the use of remote magnetic navigation and spatially targeted therapeutics in cardiology to magnetic induction hyperthermia in oncology and MRI in radiology.
Now, general surgeons like Andrew Van Osdol, MD, at Rapid City Regional Hospital are using
it to provide relief to patients with gastroesophageal reflux disease or GERD. Since late last year, Dr. Van Osdol has been offering an alternative to the standard Nissen fundoplication surgery for these patients - a tiny bracelet of magnetic beads designed to provide minimally invasive augmentation of the weak lower esophageal sphincter.
“It’s more or less become an automatic choice for me, especially for younger patients with smaller hiatal hernias,” says Dr. Van Osdol.
The force of attraction between the titanium beads of the FDA-approved LINX system keep the valve to the stomach closed. The force of a swallow, belch or vomiting open the beads.
“The cool thing about the magnets is that the further apart they get, the less attraction they have, unlike a band around that sphincter,” says Dr. Van Osdol. “Once the device is scarred in mobile, the esophagus can distend to its normal limitation.”
GERD is extremely common, affecting an estimated one in five people in the US and driving thousands to seek relief from antacids. But, as Dr. Van Osdol points out, most antacids are designed for short-term use of two to three months at a time. Emerging research suggests that people on these drugs for years could potentially raise their risk for diseases such as osteoporosis, Alzheimer’s, renal failure, heart failure, heart attack, and bacterial infections.
“Most of the time, by the time someone comes to see me, they have progressed through stronger and stronger antacid medications,” says Van Osdol. “They have gotten to the point where they either just don’t want to take antacids anymore or the antacids are no longer working for them.”
With LINX, 85 percent of patients can get off all antacids immediately and another 7 to 8 percent may only need them occasionally. The most recent data shows those figures don’t change in most patients, even after five years while 30 to 50 of Nissen patients are back on antacids after ten years.
In contrast to Nissen fundoplication, wherein the top part of the stomach is wrapped around the lower esophagus to improve the reflux barrier, LINX is less invasive, requiring five tiny incisions. Most patients can go home the same day and are able to eat a normal diet right away. Another big advantage to LINX, says Van Osdol, is that it can be removed if it ever becomes necessary.
A clinical study of 100 patients showed that difficulty swallowing, pain, and stomach bloating were the most common risks associated with the LINX System. About 9 percent require dilation of the esophagus after the surgery. Dr. Van Osdol says dysphagia has disappeared in most of his patients by about six weeks. Nationally, only 3 percent of LINX patients still have swallowing issues after a year.
While LINX is not for all patients (so far, it is only approved for those with hernias of 3 cm or less), and is not yet covered by all insurance providers, Van Osdol says it can be a life-changing option for some. The first step is to determine what is really going on.
“I encourage a referral for upper endoscopy for any patient who has had reflux for two or three years,” says Dr. Van Osdol. “Screening endoscopy will tell us if there are any pre-cancerous changes or Barrett’s esophagus. Once we have a diagnosis, we can decide which patients are good candidates for surgery and which would rather stay on their antacids.”