D Stephan1, S Attwood2, J Labenz3, F Willeke4. 1. Klinik für Allgemein‑,Viszeral- und Gefäßchirurgie, St. Marien-Krankenhaus Siegen GmbH, Kampenstr. 51, 57072, Siegen, Deutschland. dietmar.stephan@stephan-siegen.de. 2. Centre for Integrated Health Care Research, Durham University, Durham, Großbritannien. 3. Klinik für Innere Medizin, Diakonie Klinikum Jung Stilling, Siegen, Deutschland. 4. Klinik für Allgemein‑,Viszeral- und Gefäßchirurgie, St. Marien-Krankenhaus Siegen GmbH, Kampenstr. 51, 57072, Siegen, Deutschland.
Abstract
BACKGROUND: The symptoms of gastroesophageal reflux disease (GERD) are very common. Despite the fact that 40% of patients continue to suffer under conservative treatment, only approximately 1% of affected patients are operated on in Germany. Until recently, antireflux surgery was performed nearly exclusively in the form of a Nissen fundoplication or a Toupet hemifundoplication. These methods are still considered the gold standard. A new surgical minimally invasive procedure is described which treats reflux symptoms through electrical neuromodulation of the lower esophageal sphincter (LES). METHOD: An electrical neuromodulator for the LES (EndoStim®, EndoStim BV, Nijmegen, The Netherlands) is implanted into the abdominal wall as a pulse generator (IPG) and connected via an electrode cable to a pair of electrodes on the lower esophageal sphincter. In our own setting, patients are selected for this procedure after extensive functional diagnostics in the context of an interdisciplinary expert conference. The patient selection, patient education, required surgical training, surgical technique, postoperative phase as well as the results, complications and side effects are described. CONCLUSION: Electrical neuromodulation is a technique that successfully provides patients with GERD with control of their reflux symptoms. The technique requires interdisciplinary patient selection, comprehensive patient education, and comprehensive surgical training. The method is not free of postoperative problems. The electrical neuromodulation of the LES should therefore be used especially in centers with high expertise in reflux therapy.
BACKGROUND: The symptoms of gastroesophageal reflux disease (GERD) are very common. Despite the fact that 40% of patients continue to suffer under conservative treatment, only approximately 1% of affected patients are operated on in Germany. Until recently, antireflux surgery was performed nearly exclusively in the form of a Nissen fundoplication or a Toupet hemifundoplication. These methods are still considered the gold standard. A new surgical minimally invasive procedure is described which treats reflux symptoms through electrical neuromodulation of the lower esophageal sphincter (LES). METHOD: An electrical neuromodulator for the LES (EndoStim®, EndoStim BV, Nijmegen, The Netherlands) is implanted into the abdominal wall as a pulse generator (IPG) and connected via an electrode cable to a pair of electrodes on the lower esophageal sphincter. In our own setting, patients are selected for this procedure after extensive functional diagnostics in the context of an interdisciplinary expert conference. The patient selection, patient education, required surgical training, surgical technique, postoperative phase as well as the results, complications and side effects are described. CONCLUSION: Electrical neuromodulation is a technique that successfully provides patients with GERD with control of their reflux symptoms. The technique requires interdisciplinary patient selection, comprehensive patient education, and comprehensive surgical training. The method is not free of postoperative problems. The electrical neuromodulation of the LES should therefore be used especially in centers with high expertise in reflux therapy.
Authors: Leonardo Rodríguez; Patricia Rodriguez; Beatriz Gómez; Juan C Ayala; Danny Oxenberg; Alberto Perez-Castilla; Manoel G Netto; Edy Soffer; W John Boscardin; Michael D Crowell Journal: Surgery Date: 2014-11-06 Impact factor: 3.982
Authors: W F W Kappelle; A J Bredenoord; J M Conchillo; J P Ruurda; N D Bouvy; M I van Berge Henegouwen; P W Chiu; M Booth; A Hani; D N Reddy; A Bogte; A J P M Smout; J C Wu; A Escalona; M A Valdovinos; G Torres-Villalobos; P D Siersema Journal: Aliment Pharmacol Ther Date: 2015-07-08 Impact factor: 8.171
Authors: H Koop; K H Fuchs; J Labenz; P Lynen Jansen; H Messmann; S Miehlke; W Schepp; T G Wenzl Journal: Z Gastroenterol Date: 2014-11-12 Impact factor: 2.000
Authors: L Rodríguez; P Rodriguez; B Gómez; J C Ayala; D Oksenberg; A Perez-Castilla; M G Netto; E Soffer; M D Crowell Journal: Endoscopy Date: 2013-07-23 Impact factor: 10.093