Senior gastroenterologists at Shaare Zedek Medical Center in Jerusalem performed an innovative endoscopic procedure—first of its kind in Israel—designed to significantly assist patients suffering from gastroesophageal reflux disease (GERD) that may reduce the need for surgery in properly selected patients.
The procedure has already been investigated and approved for use by the FDA and endorsed by the American College of Gastroenterology. The procedure, performed in the hospital’s Digestive Diseases Institute directed Prof. Eran Goldin, was observed by fellow gastroenterologists from other hospitals across Israel to enable them to implement the approach in future cases.
Called TIF (Transoral Incisionless Fundoplication), the approach can reduce the need for more complex surgical procedures that require extensive recovery periods, and allows the patient to be released home within 24 hours and return to normal activity within a short time. Dr. Dan Livovsky, Director of the hospital’s Neuro-Gastroenterology Unit conducted the procedure with the assistance of a team from Endogastric Solutions, the company which developed the procedure approach and MDHWT Ltd., their local Israeli representative.
Acid reflux is widely regarded as one of the most common afflictions affecting people in the western world with its main symptom being heartburn. Risk factors include being overweight, smoking and excess alcoholic consumption. Epidemiological studies have found that many as ten to 20 percent of people in western counties suffer from the condition and in Israel that number is believed to be higher.
According to Dr. Livovsky, physicians in Israel primarily rely on one of two options for treating reflux.
The most common is pharmaceutical care with drugs that reduce the levels of acid that moves up from the stomach into the esophagus. On occasion these drugs can have side effects that impact on a patient’s quality of life. The secondary approach is to surgically fix a malfunctioning gastro-esophageal valve in the upper stomach. Each approach has its limitations and there is a large group of patients whose conditions don’t justify surgical intervention, but also aren’t responding to medicines (especially regurgitation of gastric contents) or that do not want to rely on daily antacid medications for the rest of their lives.
Many in this group continue to suffer from GERD symptoms for extended periods which led to the development of effective and safe approaches like TIF.
“Acid reflux occurs when the esophago-gastric valve at the lower esophagus fails which leads contents of the stomach to move upwards into the esophagus. The acid then commonly leads to heartburn. Other effects can include regurgitation of stomach content, and chest pain among other symptoms. In some instances, reflux can lead to serious medical issues like esophageal inflammation (esophagitis), stenosis, premalignant changes (Barrett’s esophagus) or even esophageal cancer,” Dr. Livovsky explains.
“With this procedure we are able to repair the functioning of the valve via an endoscope which is inserted orally without needing any incisions. The entire procedure takes about an hour and requires being in the hospital for only one day for monitoring. The patient can return to work and to full functioning within a very short amount of time. This approach can address complications and may reduce the risk of cancer as well as the need to be dependent on drugs for the rest of one’s life.”
“TIF is among the most investigated endoscopic approaches for reflux and has demonstrated very positive results. The majority of patient patients report a significant improvement in their quality of life years after undergoing the procedure, “Dr Livovsky added.
The patient at Shaare Zedek was a 46-year-old man from Jerusalem who had been suffering from intense heartburn for over a decade which was having a significantly negative impact on his quality of life. He had become entirely dependent on antacid drugs which were only having partial effect on his symptoms.
“Our sincere hope is that this approach will help this patient and many more in the future, and we take immeasurable pride in being the first medical center in Israel to embrace this approach in ways that we know can greatly enhance lives of the many people forced to deal with this condition,” Dr. Livovsky said