Do you Have Reflux or Heart Burn?
Some patients with reflux disease (GERD) suffer from long term acid reflux, heartburn, sour brush, or regurgitation. Others may have a dry cough, difficulty swallowing (dysphagia), a feeling of something stuck in the throat, hoarseness, asthma, sore throat, earaches, or even chest pain. GERD may also be associated with gas, burping, bloating, or a hiatal hernia. A Hiatal hernia is an enlargement of a natural whole in the diaphragm through which the esophagus traverses as it exits the chest and enters into the abdomen emptying into the stomach. The enlargement causes the junction where the esophagus and stomach meet to dislocate (herniate) from the abdomen into the chest. This may cause chest pain, difficulty swallowing (dysphagia), GERD symptoms, or no symptoms at all. If GERD is untreated, the consistent exposure of stomach acid to the esophagus can lead to severe inflammation (esophagitis), strictures, Barrett's esophagus, or cancer. The most common operation to fix GERD is called a a gastric fundoplication. To fix the hiatal hernia, the surgeon does a hiatal hernia repair. Since GERD is often associated with a hiatal hernia, both procedures are performed at the same time, and this is called a Nissen Fundoplication. The fundoplication can be done with endoscopy, but the hiatal hernia repair requires an abdominal surgical approach. See to learn more about this approach. Dr. Mimms will determine and discuss eligibility for endoscopic fundoplication described below. Dr. Mimms also performs therapeutic and diagnostic upper endoscopy, which is also discussed below.
Totally Incisionless Fundoplication (TIF)
This new procedure allows the surgeon to wrap the fundus of the stomach in place of a weak lower esophageal sphincter. This wrap will prevent reflux of gastric contents from the stomach into the esophagus. The wrap is created using the esophyx device and an endoscope. The procedure is performed in the operative suite. This procedure is thought to create a better fundoplication, and less bloating than traditional surgery. Watch the video by Endogastric Solutions to gain a better understanding of the procedure.
This procedure is performed in the endoscopy suite. The patient is sedated either by the surgeon or by an anesthesiologist. The endoscope is introduced through the mouth and advanced to the throat, esophagus, stomach, and first portion of the small intestine (duodenum). Each organ is evaluated carefully and thoroughly. Some patients may require endoscopy after bariatric surgery. In this case, it is imperative that a bariatric surgeon (or endoscopist with experience with bariatric patients) performs the upper endoscopy because the anatomy has been changed, and a bariatric surgeon will be familiar with the expected and unexpected changes after surgery. The procedure is performed in a similar fashion except the endoscope will not reach the remnant stomach or first portion of the intestine; however, it will reach the pouch, gastrojejunostomy anastomosis (connection between the pouch and small intestine), and a segment of the roux limb (jejunum).