Updates on LINX - GERD reflux management system

Updates on LINX - GERD reflux management system

By Brian E. Louie, MD
Director of Thoracic Research and Education

Since my initial LINX blog post 20 months ago, we have been engaged in a dialogue with patients from around the world who suffer from gastroesophageal reflux disease or GERD.  Despite my initial trepidation to “blogging”, this has been a rewarding experience to hear about patient’s problems, their concerns about the current treatments (PPI’s and Nissen fundoplication) and simply interacting with them.  I thank the patients who have taken time to share their thoughts on the blog.


When our social media manager asked me to provide an update on LINX, I realized that I have been simply responding to patient’s questions and I haven’t posted any of my thoughts or updates on what is happening with the LINX device.
There are some exciting developments for patients who are interesting in having a LINX implanted.

Use of MRI and LINX
  • Torax, the company who designed and manufactures the LINX device, has received FDA support for the use of MRI with the LINX device.  This conditional approval allows for patients to undergo and MRI that is 0.7 Tesla or less.   I am trying to clarify with our radiologists what a 0.7 Tesla MRI will cover.
Medicare coverage
  • For medicare patients, LINX now has a dedicated procedure code that allows for payment to cover the cost of the hospital portion of implanting the LINX device.  The surgeon’s fee is a separate code and fee and is usually covered.
Insurance update
  • For patients with non-medicare insurance, the battle continues.  But, the data from around the country shows that more patients are successful in getting approval for LINX than previously with upwards of 50% being approved.  It is still taking up to 120 days for approval but with more data accruing each month I think insurers are beginning to pay attention.
Since the insurance battle has been about lack of data supporting the LINX compared to Nissen, we (Drs. Farivar, Aye and Vallieres) have just completed a study comparing the two devices.  As I write this, I am on my way to the Society for Thoracic Surgeons annual meeting to present our findings, which will hopefully be published in the Annals of Thoracic Surgery later this year.
This study shows that LINX and Nissen are the same in terms of treating the patient’s symptoms of GERD, improving the patient’s quality of life and normalizing the level of reflux in the esophagus without the need for PPIs.   However, LINX is a shorter operation, has less complications and results in a more physiologic sphincter since patients are able to belch and have less bloating or gas the Nissen patients.
This promises to be an exciting year for patients with reflux.  The addition of LINX to the treatment options for GERD allows us to individualize the treatment.  For patients with large hiatal hernia, Barrett’s esophagus and severe reflux, a Nissen fundoplication performed in an experienced center is still a better option.  But, for patients with a small hiatal hernia who are dependent on PPIs but whose reflux is not well controlled, a LINX device is a great option.
Thank you to all the patients who have read and interacted in this blog.  I look forward to reading your posts in the coming year.
Brian E. Louie, MD
Leslie, I think that your candidacy for LINX will heavily depend on your gastroparesis. You should have studies to determine how severe your gastroparesis is. It's likely that your bloating symptoms are from the gastroparesis as is your reflux. LINX will help with your reflux but won't help the gastroparesis and you are likely to have ongoing symptoms. From what you tell me, your best to make sure the treatment you get treats both. In that case, a Nissen is likely to be better if you have moderate gastroparesis since the Nissen will help your stomach empty.

It sounds like you are seeing a gastroenterologist and not a surgeon. I'm not sure if that is correct, but your situation is more complicated than a patient with no gastroparesis. You may wish to see both a surgeon and gastroenterologist to get several opinions.
4/7/2014 4:07:54 PM
Brian E. Louie, MD

Thanks for your post. Your story is very similar to many patients with GERD. They start on PPIs and feel improved. Overtime, they have more symptoms and undergoing an increase in the dose of PPIs. It sounds like you'd be a great candidate for LINX. I would not classify us as "still working" on the LINX. I think we have a very good idea of who will benefit.

I think your worries over Barrett's and cancer are real to you. The numbers would suggest that your risk is really small. These reasons should not be your primary reason for deciding about surgery for reflux. At the moment, the key would be better control of symptoms and reflux control. Both Nissen and LINX would be suitable alternatives.

I suggest you go back to your surgeon for more discussion. If you are not comfortable with the surgeon, then seek one you are comfortable with.
4/7/2014 4:07:23 PM
Joanne Taravella
I am interested in the LINX surgery.
I read PPI's don't stop the progression of GERD.
Also I read that they don't prevent Barrets or cancer.
I went to a surgeon last year to see if I was a candidate
for the LINX and he told me to keep taking PPI's for now
because there still working for the most part.
I have had GERD for many years now and I have to take
these PPI meds.every, and this year I am noticing breakthrough symptoms more and had to go up on my dose.
My fear is that I will get Barrets or worse and won't be able to get the LINX.
The surgeon said to come back in a year.
He also told me that I seem like the nevous type and would worry alot after the opetation about the device inside me.
I worry now anyway so what's the difference.
He mentioned having a nissen and I am hesitant about it because of what I read and heard.
4/4/2014 8:13:42 PM
Leslie Mercer
I have gerd esophagitis and gastroparesis with frequent belching.Would I still be a candidate? Is there much gastointestinal bloating from the Linx?I'm being following by GI who does Linx and has "scheduled" me to see him on April 20.
4/4/2014 1:03:58 PM
Brian E. Louie, MD
3/5/2014 3:35:26 PM
Wondering how many of this procedure Swedish has performed to date.
3/5/2014 3:14:24 PM
Kevin Owens
I had a Nissen in 2006 that is in a failure mode. A recent endoscopy showed light from the stomach escaping around the device shaft. I hate to think of having a repeat Nissen surgery every 8-10 years. Can I have LINX surgery this time around and reverse the previous Nissen and expect more longevity out of the Linx?
3/5/2014 11:44:42 AM
Would this be an option for people with Bile reflux?
2/26/2014 2:26:18 PM
Brian E. Louie, MD
Yes, very exciting.

there has not been much research on the satisfaction of LPR patients with LINX. there was one study looking at patients with atypical symptoms for which LPR fits into that category. Patients did benefit but it was not designed specifically for LPR.

In our own experience the LPR patients do very well, but its not perfect. However, it may be more suitable than a Nissen for most LPR patients who don't have severe GERD symptoms as well.
2/24/2014 10:28:16 AM
This is very exciting news!

Has there been much research on the satisfaction of LPR patients with the Linx procedure?
2/14/2014 6:18:09 AM
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