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• W2075530618 abstract "In this issue of Surgical Endoscopy, Torquati and Richards provide an excellent, evidence-based review of the status of endoluminal therapy for gastroesophageal reflux disease (GERD) [1]. Their review highlights some of the challenges faced by evolving techniques and technologies in minimally invasive surgery and surgical gastroenterology. The issues raised are worthy of reflection for what they can teach us about evolving areas of gastrointestinal surgical practice. The obvious draw of endoluminal therapies for GERD was their collective potential to allow an inside or minimally invasive approach to a highly prevalent medical problem. The potential for such treatments to be done in outpatient settings, under sedation rather than anesthesia, without violation of the peritoneal space, all made great intuitive sense from a patient care and cost perspective. Based on understanding of the anatomic and physiologic functions of the gastroesophageal junction that was derived from open and laparoscopic experience with antireflux surgery, a number of techniques that attempted to augment the lower esophageal sphincter area via an endoluminal approach were developed. Bulking agents, suturing techniques, and even novel thermal deployment strategies were developed and brought to trial. Credible investigators worked with industry on the development of these tools and their initial trialing in both animal and human settings. The future seemed hopeful, the opportunity significant, the approach scientific. From the start however, there was, at least from the standpoint of surgical experience, something of interest, if not concern with these techniques. Their application was targeted on patients who fell outside the range of disease the surgical practitioner would have normally deemed appropriate for invasive intervention. Moderately sized hiatal hernias (> 2 cm), intestinal metaplasia, patients with atypical symptomatology, and advanced esophagitis patients were excluded. As at least one experienced medical esophagologist commented, as the techniques were deployed and initial data on their efficacy began to accumulate, they seemed to work best on the patients who needed them least. The main benefit, it seemed, would be a perhaps transient reduction in medication usage, an arguable expectation of cost savings if that could be achieved, and this would of course all be excusable because the techniques were noninvasive, and could even be applied repetitively if necessary. As Torquati and Richards so nicely summarize, the" @default.
• W2075530618 created "2016-06-24" @default.
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• W2075530618 date "2007-03-28" @default.
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• W2075530618 title "Endoluminal GERD therapy: inside, outside, upside, downside" @default.
• W2075530618 cites W2009970733 @default.
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• W2075530618 doi "https://doi.org/10.1007/s00464-007-9343-4" @default.
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