Clinician-to-Clinician Update Clinician-to-Clinician Update

New Minimally Invasive Treatment for GERD

July 2015

Gastroesophageal reflux disease (GERD) is prevalent in the United States, with reported rates from 18.1% to 27.8% nationwide and 18.1% to 19.9% in the Midwest.1 For patients with chronic GERD who do not respond to maximal medical therapy, surgery is often indicated. Historically, Nissen fundoplication has been the gold standard for surgical management of the condition. However, another laparoscopic option is now available. Implantation of the LINX® Reflux Management System may provide symptom relief, along with a faster recovery time and a more favorable side-effect profile than typical with traditional Nissen fundoplication.2 The University of Minnesota Health thoracic program is among the first in the Midwest offering this surgical option for patients.

Linx 1011 seconds-974x645
LINX 1 HR-443x498
— Made up of magnatized titanium beads, the LINX System is designed to encircle the lower esophageal sphincter. Illustration reprinted with permission of Torax Medical, Inc.

The LINX System is comprised of interlinked titanium beads with magnetic cores that encircle and support the function of the lower esophageal sphincter. The magnetic attraction between the beads lets the LINX System help the esophageal sphincter stay closed and prevent reflux. Supported by 2 FDAregulated IDE trials, the LINX System was unanimously approved by the FDA in March 2012.

Unlike Nissen fundoplication, in which gastric folds are wrapped around the esophagus, implantation of the LINX System leaves the native anatomy intact. This means the procedure is reversible. After the surgery and unlike the case with traditional surgical approaches, patients experience little or no gas bloat and can belch and vomit. Patients are able to return to normal activities almost immediately, while Nissen fundoplication often requires several days’ recovery.

To date, the LINX System has been implanted in over 1,000 patients worldwide with over 6 years of follow-up. Very positive outcomes have been reported.3 In year 2 of a 5-year, multicenter study of 100 patients, 90% of patients experienced a reduction in total acid exposure time, 93% of patients achieved at least a 50% reduction in GERD-HRQL score, and 85% of patients eliminated daily dependence on proton pump inhibitors.4

During 5 years of clinical experience with LINX, no deaths, disabilities or permanent damage, or intra-operative complications have been reported, and there have been no known device failures or migrations.3, 4 Reported patient satisfaction levels are very high.2, 4 The clinical outcomes thus far support the use of the LINX System as a new treatment option for patients with GERD. 

References

1. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-esophageal reflux disease: a systematic review. Gut. 2014 Jun;63:871-80.

2. Louie BE, Farivar AS, Shultz D, et al. Short-term outcomes using magnetic sphincter augmentation versus Nissen fundoplication for medically resistant gastroesophageal reflux disease. Ann Thorac Surg. 2014 Aug;98(2):498-504.

3. Lipham JC, Taiganides PA, Louie BE, et al. Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease. Dis Esophagus. 2015 May-Jun;28(4):305-11.

4. Ganz RA. Long-term outcomes of patients receiving a magnetic sphincter augmentation device for gastroesophageal reflux. Clin Gastroenterol Hepatol. 2015 Jun 1. pii: S1542-3565(15)00763-6. doi: 10.1016/j.cgh.2015.05.028.

When to refer

University of Minnesota Health specialists in thoracic surgery and gastroenterology provide innovative care for complex problems of the esophagus, including gastroesophageal reflux disease (GERD). Our surgeons, physicians, nurses, and specialists provide compassionate, comprehensive care with a crossdisciplinary approach that results in optimal treatment and outcomes.

To schedule a consultation, referral or appointment:
612-624-LUNG (5864)


Indications for LINX implantation:

• A diagnosis of GERD as defined by abnormal pH testing

• Chronic GERD symptoms despite maximum medical therapy for the treatment of reflux

• Patients 21 years of age or older

Contraindications:

• Suspected or known allergies to titanium, stainless steel, nickel, or ferrous materials

• Morbid obesity (BMI >35)

• Barrett’s esophagus

• Large hiatal hernias (>3 cm)

• Esophageal motility disorders

• Esophageal or gastric varices, esophageal or gastric cancer, esophageal strictures

• Electrical implants (such as pacemakers or implantable defibrillators) or metallic implants in the abdomen

• Comorbidities requiring regular performance of MRI studies

Collaborative Care

When you refer a patient to us, you are receiving the resources of a cohesive team of surgeons, physician assistants, nurses, and specialists who work with you to ensure that your patient receives the best possible care. We work closely with gastroenterologists, primary care providers and other referring providers on reviewing patient selection criteria, ensuring proper work-up, and communicating postprocedure expectations and care.

We are committed to communicating our findings and recommendations with you promptly and to coordinating follow-up care with you and your patient. We will send you a follow-up letter shortly after your patient’s visit. We can provide an even prompter response to physicians who provide an email or phone number. 

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