Specialists at Jerusalem’s Shaare Zedek Medical Center (SZMC) have performed for the first time in Israel an innovative endoscopic procedure that successfully treats patients suffering from heartburn acid reflux and can come instead of surgery.
The safe and innovative treatment has been researched and approved by the US Food and Drug Administration (FDA) and was recently included in the guidelines for the treatment of reflux by the American College of Gastroenterology.
Acid reflux occurs when the sphincter muscle at the lower end of the esophagus relaxes at the wrong time, allowing stomach acid to back up into the food tube. This condition can cause heartburn and other signs and symptoms, but when it becomes chronic, it can lead to gastroesophageal reflux disease (GERD), in which the acid irritates the lining of the esophagus. People with GERD have a slightly higher risk of getting pre-malignant and even malignant adenocarcinoma of the esophagus.
When lifestyle changes and medications aren’t enough
Most people are able to manage the discomfort of GERD with lifestyle changes and medications, but some have had to undergo surgery to ease symptoms. Gastroenterologists from the largest Israeli hospitals watched as Dr. Dan Meir Livovsky, a senior gastroenterologist and endoscopist, and Prof. Eran Goldin, head of SZMC digestive diseases institute. performed the procedure. They were supported by Endogastric Solutions of Redmond, Washington, which developed the innovative treatment, and Medhot, the importer of dental supplies in Israel.
The minimally invasive endoscopic operation called transoral incisionless fundoplication (TIF) reconstructs the valve between the stomach and esophagus. Fundoplication means folding of the fundus, the tissue at the top of the stomach.
By folding the fundus around the opening between the stomach and esophagus, a gastroenterologist reinforces this area to prevent stomach acid from coming up into the esophagus. Fundoplication helps create a new barrier to reflux from the stomach. Transoral means the procedure is done through the mouth without any external incisions. TIF can replace open surgery that involves a long recovery and makes possible a quick return to routine without incisions within 24 hours.
Acid reflux is incredibly common
Reflux is one of the most common diseases in the Western world and in Israel, when the main symptom is heartburn. The risk factors for reflux are obesity, smoking and drinking alcohol. In a systematic review of 15 epidemiological studies, the prevalence of reflux disease was found to be 10% to 20% of the population in the Western world, and in Israel it is tens of percent of patients who suffer from this phenomenon at least once a year.
Livovsky said that two treatments are offered for acid reflux – pills that reduces the level of acidity of the liquid that rises from the stomach to the esophagus, but sometimes they cause various side effects that can impair daily functioning. In addition, fluid continues to rise from the stomach into the esophagus (albeit not acidic), which can cause symptoms and impairs the quality of life.
The second treatment is a complex operation in which the surgeon uses the upper part of the stomach around the esophagus to restore the valve that does not work properly and repair a hernia in the diaphragm if there is one. Between these two treatments, there is a group of people who are not sick enough to justify surgery on the one hand and for whom the drug treatment does not provide a satisfactory answer or who are not interested in taking medication for example their whole life. Thus, these people continue to suffer from persistent symptoms and side effects.
The new treatment and its advantages
“In the treatment, we perform a reconstruction of the esophageal valve with a normal endoscopy through the mouth without incisions. The treatment takes about an hour and involves hospitalization for a day only, for supervision. The patient can return to work and normal life in a short time. The repair prevents complications, treats symptoms, can prevent esophageal cancer and the need to take medication for life.
Of the many endoscopic developments that exist in the world today for the treatment of reflux, TIF is the treatment that has been studied the most with good results, with 80% of the patients who underwent the procedure reporting after seven or eight years an improvement in their quality of life, said Livovsky.
“Thanks to the satisfactory results, this treatment is included in the guidelines for reflux treatment, since it is a common phenomenon with a significant impairment in the quality of life of many patients, we decided to bring this method to Israel.
“The first patient, M., a 46-year-old Jerusalemite who suffered for over a decade from reflux that led for heartburn, hoarseness and a persistent impairment of his quality of life. M. is completely dependent on antacids which unfortunately only partially helped. We hope that the treatment will help M. and hundreds of other patients across the country. We are proud to be the first Israeli medical center in Israel to adopt such innovative approaches to improve the quality of life of our patients.”