Plicator
in [Heart Medication]
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From: Derek F on 4 Dec 2005 11:08 Recently read a UK news article about a new treatment for heartburn. As it has been around in America for longer does anyone have experience of it? http://www.ndosurgical.com/index.html Derek.
From: Howard McCollister on 4 Dec 2005 11:30 "Derek F" <lordpilrig(a)NOXbtinternet.com> wrote in message news:dmv4a7$l8f$1(a)nwrdmz02.dmz.ncs.ea.ibs-infra.bt.com... > Recently read a UK news article about a new treatment for heartburn. As it > has been around in America for longer does anyone have experience of it? > http://www.ndosurgical.com/index.html > Bard had/has the Endo-Cinch for years in the US. It plicates the mucosa. It's a miserable failure. The Plicator is different in that it's a full thickness sewing machine. It's way, way too early to tell it it's going to be useful, or have any realistic comparison to the gold standard - gastric fundoplication. The main reason one might want to avoid a Nissen is the side effect of gas/bloat. Be aware that there is no real good way to repair a defective LES without causing some of that. All of the lesser technologies like EndoCinch, Enteryx, GateKeeper, Stretta have been nice in that they have few or *no* such side effects, but the downside is that they just don't work. Hard to tell at this early stage, but my long experience in this arena makes me highly suspicious that the Plicator will end up being just another half-measure that will ultimately fall by the wayside and land in the same heap as the above technologies. Time will tell. HMc
From: Mr Wal on 12 Dec 2005 07:38 Hi there Howard, I have been a reader of this newsgroup for a number of years, but never actually said anything :) I thank you for your insights and comments and observations. I have a question re your comments below: Howard McCollister <nospam(a)nospam.net> wrote: > The main reason one might want to avoid a Nissen is the side effect of > gas/bloat. Be aware that there is no real good way to repair a defective LES > without causing some of that. All of the lesser technologies like EndoCinch, > Enteryx, GateKeeper, Stretta have been nice in that they have few or *no* > such side effects, but the downside is that they just don't work. So your opinion is that the Stretta procedure is not useful for GERD? My reading had said that it worked for a while then needed to be re-done, but I'm interested in your comment above. My gastro also thought that stretta was not a particularly good solution to GERD as well, but it was about 3 years ago when I talked to him about it. At the moment 20 mg of Somac once every 2 days seems to placate my GERD symptoms. As a result I dont think that I particularly want to do any surgery. Do you think that this is a reasonable long term choice? I have been on Somac for probably around 6 years or so now, possibly a bit longer. Regards Chris.
From: Howard McCollister on 12 Dec 2005 14:27 "Mr Wal" <superwally(a)gmail.com> wrote in message news:439d6f32$0$18197$afc38c87(a)news.optusnet.com.au... > Hi there Howard, > > I have been a reader of this newsgroup for a number of years, but never > actually said anything :) I thank you for your insights and comments > and observations. > > I have a question re your comments below: > > Howard McCollister <nospam(a)nospam.net> wrote: >> The main reason one might want to avoid a Nissen is the side effect of >> gas/bloat. Be aware that there is no real good way to repair a defective >> LES >> without causing some of that. All of the lesser technologies like >> EndoCinch, >> Enteryx, GateKeeper, Stretta have been nice in that they have few or *no* >> such side effects, but the downside is that they just don't work. > > So your opinion is that the Stretta procedure is not useful for GERD? My > reading had said that it worked for a while then needed to be re-done, but > I'm interested in your comment above. My gastro also thought that stretta > was not a particularly good solution to GERD as well, but it was about > 3 years ago when I talked to him about it. > > At the moment 20 mg of Somac once every 2 days seems to placate my GERD > symptoms. As a result I dont think that I particularly want to do any > surgery. Do you think that this is a reasonable long term choice? I have > been on Somac for probably around 6 years or so now, possibly a bit > longer. > Of all of the alternate technologies, the Stretta procedure is probably the most useful, but its success rate is relatively low - about 70% of GERD patients who have a Stretta will be off of their meds in 1 year. Now, I suspect one of the reasons for the low success rate is that Stretta has been applied to all GERD patients, whereas I believe that there is only a subset for whom it is optimally applicable. I have done many, many Strettas. I believe that the best patients are those whose GERD is related to transient inappropriate LES relaxation, but have a normal to low-normal resting LES pressure. Another category where I think the Stretta may work fairly well are those GERD patients whose primary cause is a low resting LES pressure, but not TOO low. Any obvious laxity of the LES on EGD, or resting LES pressures less than about 15 mmHg will have predictably less success IMHO. In those two categories, I will offer Stretta as an option, and it's not a bad thing to try. It's not painful, has very few (if any) side effects, is very safe, and is an outpatient procedure with virtually no time off work. And, if it doesn't work, it does not impair the possibility of a Nissen later on. HMc
From: louise on 17 Dec 2005 04:29 Howard McCollister wrote: > "Mr Wal" <superwally(a)gmail.com> wrote in message > news:439d6f32$0$18197$afc38c87(a)news.optusnet.com.au... > >>Hi there Howard, >> >>I have been a reader of this newsgroup for a number of years, but never >>actually said anything :) I thank you for your insights and comments >>and observations. >> >>I have a question re your comments below: >> >>Howard McCollister <nospam(a)nospam.net> wrote: >> >>>The main reason one might want to avoid a Nissen is the side effect of >>>gas/bloat. Be aware that there is no real good way to repair a defective >>>LES >>>without causing some of that. All of the lesser technologies like >>>EndoCinch, >>>Enteryx, GateKeeper, Stretta have been nice in that they have few or *no* >>>such side effects, but the downside is that they just don't work. >> >>So your opinion is that the Stretta procedure is not useful for GERD? My >>reading had said that it worked for a while then needed to be re-done, but >>I'm interested in your comment above. My gastro also thought that stretta >>was not a particularly good solution to GERD as well, but it was about >>3 years ago when I talked to him about it. >> >>At the moment 20 mg of Somac once every 2 days seems to placate my GERD >>symptoms. As a result I dont think that I particularly want to do any >>surgery. Do you think that this is a reasonable long term choice? I have >>been on Somac for probably around 6 years or so now, possibly a bit >>longer. >> > > > Of all of the alternate technologies, the Stretta procedure is probably the > most useful, but its success rate is relatively low - about 70% of GERD > patients who have a Stretta will be off of their meds in 1 year. Now, I > suspect one of the reasons for the low success rate is that Stretta has been > applied to all GERD patients, whereas I believe that there is only a subset > for whom it is optimally applicable. I have done many, many Strettas. I > believe that the best patients are those whose GERD is related to transient > inappropriate LES relaxation, but have a normal to low-normal resting LES > pressure. Another category where I think the Stretta may work fairly well > are those GERD patients whose primary cause is a low resting LES pressure, > but not TOO low. Any obvious laxity of the LES on EGD, or resting LES > pressures less than about 15 mmHg will have predictably less success IMHO. > > In those two categories, I will offer Stretta as an option, and it's not a > bad thing to try. It's not painful, has very few (if any) side effects, is > very safe, and is an outpatient procedure with virtually no time off work. > And, if it doesn't work, it does not impair the possibility of a Nissen > later on. > > HMc > > > Would you recommend a stretta rather than have someone on something like Prevacid 30mg/day with occasional weeks of 60mg/day to calm things down? In other words, is the Stretta preferable to the proton pump inhibitors? TIA Louise
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