Upcoming GERD talk at Swedish Issaquah on 9/26

Upcoming GERD talk at Swedish Issaquah on 9/26

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

LINX has arrived at Swedish! After several months of preparation, we will be implanting the first 3 LINX devices on September 21, 2012. For our 3 adventurous patients, we are excited to see them have their GERD controlled with the LINX and also hope that it meets their expectations.

To learn more about this procedure and others options for managing GERD, you may wish to come and hear my partners Dr. Ralph Aye and Dr. Alex Farivar talk at Swedish Issaquah on September 26th, 2012. For more information and to register for the 9/26 GERD class, click here.

Update on 9/23: I am happy to report that our patients who have received the LINX device are all doing well. 

Comments
Brian E. Louie, MD
Lat, my apologies for the delay in responding.

This has been a relatively quiet year for LINX which is often good in surgery. There have been no changes in the rates of migration or failure. In fact, we just completed a large study comparing LINX to Nissen and found that the LINX has a very consistent result. It takes away symptoms, only 15-20% of patients still require some PPIS and most patients can belch and have little bloating.

We have confirmed 6 erosion in over 3000 device implants for a very late 0.2% rate.

Probably the biggest news is that the issue of MRI compatibility will be resolved very soon.
5/11/2015 10:56:07 AM
Brian E. Louie, MD
Kelly, I'd suggest you have your primary care MD send a referral and records to my office to review.

We can then set up an appointment to discuss.

If you are candidate for Nissen and you don't have a larger hiatal hernia you are likely a candidate for LINX.
5/11/2015 10:55:15 AM
Brian E. Louie, MD
Elizabeth, the LINX device requires existing normal structures to work with the device to provide a barrier to GERD. After a fundoplication, those usual structures have been taken apart. As we gain more experience and understanding with the device, we may be able to answer your question. But, at the current time, it has not been done.
5/11/2015 10:54:41 AM
Elizabeth Convis
My son had a fundal done at 3. He is 17 now and his fundal is failing. Would he be a canadate for this procedure
5/4/2015 6:05:32 PM
Brian E. Louie, MD
Mark, I have not seen or heard of any patients developing heart problems from PPI usage, but that doesn't mean it isn't possible.

Can you share some more information?
9/15/2013 8:29:22 PM
mark
Dr. Louie,

Have you ever heard or seen any patients develop heart problems/arrhythmia due to PPI usage?
9/15/2013 8:06:10 PM
Brian E. Louie, MD
You have had a complete work up and it seems that you may have GERD. Belching is usually a side effect of swallowing repeatedly whether subconsciously or deliberate.

I would not recommend a gastropexy. It is unlikely to help since it does not treat GERD and you would have a tube coming out of your stomach which can have significant problems.

In addition your theory isn't applicable to the small hernia. The belching is related as I said to air swallowing.

Dysphagia or trouble swallowing after LINX is variable with some patients having none and others having some. By three months after placement almost everyone is back to normal. Our patients don't find this to be an issue.

Read more in this NEJM study: http://bit.ly/XC9D6j
2/21/2013 12:03:41 PM
Ozzie
Thank you for your previous reply.

My chief complaint has been post-prandial belching and throat hoarseness for the past 3 years. Bowel sounds in the chest are loud and frequent. Upper GI series and Endoscopy showed reflux and small hiatal hernia (2-3 cm). High resolution manometry was negative for hiatal hernia, but showed shortened LES length and intrabdominal LES length. LES pressure was 13 mmhg. PH Monitoring showed increased reflux during belching episodes, but was otherwise normal acid exposure. Finally, my symptoms are exacerbated by coffee, chocolate, alcohol and respond fairly well to PPIs and baclofen. I am fairly confident this is a GERD issue, but I guess it could be functional dyspepsia as well.

I wanted to get your opinion on whether a simple gastropexy might benefit a patient like me without stereotypical heartburn. I read that this procedure has been done via endoscope in surgically unfit patients with paraesophageal hernias. I feel as though my belching is mostly caused by the GEJ junction sliding past the diaphragm and I hypothesize that if the stomach was pulled down into the abdominal cavity, my belching would be relieved. What are your thoughts on this possibility? I'm assuming this hasn't been tried before, but I thought I would ask anyways.


Also regarding the Linx, how problematic is the common side effect of dysphagia? Are most patients satisfied with the trade-off?
2/19/2013 9:41:19 PM
Brian E. Louie, MD
Patients who are eligible for implantation of a LINX device at the current time can have a small hiatal hernia. If we repair the hernia it is done with suture only. No mesh. It is not always necessary to repair this very small hernias but that decision is made during the operation.
11/19/2012 8:39:02 AM
Ozzie
Dr. Louie,

Are you performing this operation on patients with small hiatal hernias? If so, are you closing the hiatus with sutures or mesh?

Best,

Ozzie
11/18/2012 9:44:17 PM
Brian E. Louie, MD
Insurance approval whether it is medicare, medicaid or commercial is being carefully scrutinized by the insurers. Some have been accepting while others have not. It is best to see the surgeon and discuss whether you are a candidate for the procedure and then seek insurance approval.
9/24/2012 8:43:14 AM
Pete
Does this surgery accept medicare?
9/21/2012 10:06:06 AM
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