Treatment of Gastroesophageal Reflux Disease (GERD)

Dr. Christy Dunst The LINX device is designed to expand and astroesophageal reflux disease (GERD) their referrals for this procedure to patients contract when food is GASTROINTESTINAL is a common ailment affecting millions with large hiatal (more than 2 cm) or G swallowed or when there is & MINIMALLY INVASIVE of patients. Many of these patients are not advanced GERD. a need to belch or vomit. SURGERY sufficiently treated with medical therapy alone. TIF 4805 NE Glisan Street, Suite 6N60 TIF is similar to laparoscopic fundoplication Portland, OR 97213 As leaders in the treatment for GERD, our in that it involves using existing esophageal surgeons offer comprehensive esophageal physiology to create an antireflex valve. diagnostic evaluation to determine an However, it is performed endoscopically, appropriate treatment plan. Surgical options which results in reduced discomfort, a available include laparoscopic fundoplication, quicker recovery, and greater overall patient trans-oral incisionless fundoplication (TIF), satisfaction than traditional laparoscopic endoscopic radiofrequency therapy (Stretta), fundoplication. For these reasons, TIF can and magnetic lower esophageal sphincter be a great choice for many patients suffering augmentation (LINX). from GERD, particularly for those patients who are also in need of a a smaller (less than Laparoscopic Fundoplication 2 cm) repair. LINX OPEN LINX CLOSED Laparoscopic fundoplication is the traditional adjacent beads helps the LES resist opening surgical procedure for the treatment of Stretta due to gastric pressure, preventing reflux GERD. The upper curve of the , Stretta provides treatment of GERD through from the stomach into the . The the fundus, is wrapped around the bottom the insertion of a catheter into the esophagus device is designed so that the magnetic GASTROINTESTINAL & MINIMALLY INVASIVE SURGEONS of the esophagus and sutured into place. to deliver radiofrequency energy to the lower bond is temporarily broken when a patient This strengthens the valve between the esophageal sphincter (LES), muscle, and swallows food, belches or vomits. Patients NEWSLETTER | WINTER 2O16 | ISSUE 3 esophagus and stomach, which prevents gastric cardia. While this method is the least remain in the hospital less than 24 hours and stomach bile and acid from backing up, invasive approach, it also better suited for are generally back to work in a week. Like but may also cause trouble , patients who require less aggressive GERD other minimally invasive surgeries, there is increased gas or bloating and an inability treatment. minimal pain. Unlike fundoplication, it doesn’t to belch and vomit. Despite the fact that a require dividing any of the blood vessels or majority of patients do well with this surgery, LINX changing the natural anatomy of the stomach. the potential for such side effects remains a LINX involves implanting a small device to concern. Consequently, physicians may limit tighten the opening of the LES and stop The Oregon Clinic was one of only 13 reflux while allowing the patient to eat centers in the United States to participate In fundoplication, the normally. Using minimally invasive surgical in the clinical trial that led to FDA approval fundus is wrapped techniques, the LINX device is implanted in March 2012 and which concluded in around the esophagus under general anesthesia during a procedure 2015. One hundred adult GERD patients to create an antireflux that lasts about 45 minutes. who were surgical candidates elected to valve participate in the trial. After following these The device consists of a tiny band of patients for five years, we found significant interlinked titanium beads with magnetic improvement in the quality of life with no cores, placed around the gastroesophageal serious complications and few side effects as WORLD-CLASS ESOPHOGEAL CARE junction. The magnetic bond between compared to traditional GERD surgery.

he esophageal surgeons of The Oregon Clinic are internationally recognized AREAS OF EXPERTISE Tas providers of the most advanced and comprehensive care of all aspects of Celebrating the Publication of Antireflux Surgery Textbook esophageal and gastric diseases. Our commitment to excellence is demonstrated by he Oregon Clinic celebrates the publication of Antireflux Surgery textbook (Springer 2015, Editors our superior outcomes, continuous quality assessment, high patient satisfaction, and Lee Swanstrom and Christy Dunst) as a collective effort of our esophageal surgery group along with • Gastroesophageal reflux disease (GERD) T more than 300 peer reviewed publications. expert colleagues from around the world. • Hiatal hernia • Barrett’s esophagus We are proud to welcome Dr. Steven DeMeester to The Oregon Clinic. This book provides a comprehensive, state-of-the-art overview of the major issues specific to the • Esophageal With 20 years of experience, Dr. DeMeester is one of the most well- field of antireflux surgery. It provides instructional detail regarding performance of antireflux surgery • Gastroparesis respected and accomplished esophageal surgeons in the world. He from leading esophageal surgeons and • Achalasia and other motility disorders is a leading expert in and complex esophageal is the only resource of its kind dedicated • Swallowing disorders diseases. His thoracic surgery background and his interest in specifically to the issues unique to • Esophageal diverticulum advancing minimally invasive esophageal surgery (including Refer Your Patients - Your Way advanced endoscopic procedures) complements our group. antireflux surgery. • Gastric tumors Your EMR oregonclinic.com/refer (5O3) 925-3122 • Complex esophagogastric surgery GASTROINTESTINAL & MINIMALLY INVASIVE SURGEONS NEWSLETTER • WINTER 2016 About the Gastrointestinal & Minimally Invasive Surgeons (GMIS) Esophageal and Gastric Cancer Innovation Dr. Kevin Reavis Our group has 20 years of history in program, procedure, and instrument development. arly diagnosis of esophagogastric cancer Our surgeons also offer a cryoablation as another useful Focused Areas of Expertise Eis the best way to achieve a cure. As full range of organ-sparing, ablative tool to the region. We are dedicated to providing high-quality experts in this cancer, our surgeons are advanced therapeutic When is care using the latest technology. Our adept at both prevention and treatment. endoscopic options to required, our surgeons have surgeons focus on the following fields of remove suspicious lesions superior experience with more surgery: In addition to high-definition narrow- and early cancer, including than 1,000 cases collectively. band imaging diagnostic , our radiofrequency ablation and • Endocrine Surgery • Colon & Rectal Surgery surgeons are the only providers in Oregon endoscopic resection. Esophageal and We emphasize oncologic to offer endomicroscopy with optical Gastric Cancer principles and long-term quality • Gastric & Esophageal Surgery technology to diagnose dysplasia and early Recently, The Oregon Clinic of life through minimally invasive, • cancer. esophageal surgeons have introduced vagal-sparing and en-bloc esophagectomy. • Liver, Biliary & Pancreas Surgery • Vein Treatment

Research Back: Drs. Newell, Hayman, Hammill, Breen, Ahmad, O’Brien, Zelko, Swanstrom, Wolf • Active clinical and basic science Front: Drs. Hansen, Jamison, Aliabadi-Wahle, Dunst, Whiteford, Reavis Treatment of Achalasia: Per-oral Endoscopic Myotomy (POEM) research program • Participation in multi-institutional Dr. Christy Dunst research efforts Active Participation in Education We have four clinical fellowships accredited • Internal quality assessment and the Medical Community by the Accreditation Council for Graduate pproximately one in every 100,000 (LES) fails to relax and open. lining to allow passage of a improvement Our doctors hold leadership roles in the Medical Education (ACGME) in: people per year experience achalasia, It has no known underlying flexible endoscope and other • Publications include: A most well-respected hospital systems in the • Liver and Pancreas Surgery a condition characterized by swallowing cause, though it is associated instruments into the wall of the -- Three current textbooks Portland metropolitan area and in regional • Minimally Invasive Surgery difficulties, regurgitation, and sometimes with the failure or loss of esophagus. The surgeon uses -- More than fifty book chapters and national specialty societies. • Foregut Surgery . It occurs when the smooth certain in the wall of heat to destroy the muscles of -- Over 300 peer reviewed papers • Colorectal Surgery muscle layer of the esophagus doesn’t move the esophagus. the lower esophageal sphincter food down the esophagus to the stomach and then removes the tools and properly and the lower esophageal sphincter Traditional treatments for achalasia POEM closes the small incision. Dr. Lee Swanstrom Receives Award include the injection of , stretching the LES with a balloon, and In 2010, the esophageal surgeons of for Lifetime Achievement in Surgery surgery, all of which reduce the pressure The Oregon Clinic were the first surgeons Nearly 300 POEM within the LES to allow easier passage of in the United States to perform POEM as a ee Swanstrom, MD received the George food. treatment for achalasia. Berci Lifetime Achievement award from procedures have The Foundation for Surgical Innovation L the Society of American Gastrointestinal and and Education (TFSIE) is a non-profit been performed by our Per-oral Endoscopic Myotomy (POEM), is Since then, nearly 300 POEM procedures Endoscopic Surgeons (SAGES) on April 15, founded in 2009 by GMIS to support quality a less invasive, permanent treatment for have been performed by our group with more 2015. group with more than a in research and education in the field of esophageal achalasia. It is performed than a 95% success rate. Patients appreciate Minimally Invasive Surgery. It is lead by Dr. 95% success rate. under general anesthesia and involves POEM because it is an effective procedure The award is the highest honor SAGES Swanstrom, Dr. Dunst, and Dr. Reavis. making a tiny incision in the esophageal with very little down-time and virtually no pain. bestows and is not given every year. It is

granted only when SAGES finds a worthy Many GMIS partners serve as members of nominee with a lifetime of scientific, TFSIE's innovations team. The TFSIE Board technological, or educational contributions is composed of recognized leaders in Esophageal Diagnostics Laboratory as an innovator in endoscopic surgery. surgery from across the United States.

SAGES represents more than 7,000 Our team works together to TFSIE funds deserving research and Testing Includes: surgeons globally. The organization was ensure patients receive world- education efforts in a non-biased and founded to support academic, clinical and class service at our convenient • High-resolution esophageal scientific manner. TFSIE manages these research achievement in gastrointestinal in-office Esophageal Diagnostics manometry (HRM) funds with minimal administrative cost to endoscopic surgery. Laboratory. maximize TFSIE's mission. • Traditional and wireless pH Dr. Lee Swanstrom, testing Dr. Swanstrom has been an inspirational The Oregon Clinic - Gastrointestinal & As the largest surgical esophageal • Impedance testing TFSIE is proud to regularly offer intensive visionary, dedicated mentor and technical Minimally Invasive Surgery physiology laboratory in the • Restech Laryngeal pharyngeal educational courses designed to help master during his nearly 20 years as a Pacific Northwest for more than reflux (LPR) testing surgeons acquire the skills necessary to Severe Esophageal partner at The Oregon Clinic. 20 years, we offer comprehensive • Sedation free trans-nasal safely and competently perform complex Dysmotility High Resolution Manometry Congratulations Dr. esophageal testing using the most endoscopy procedures such as POEM. up-to-date equipment available. Swanstrom! Learn more at tfsie.org Refer Your Patients - Your Way Your EMR oregonclinic.com/refer (5O3) 925-3122 GASTROINTESTINAL & MINIMALLY INVASIVE SURGEONS NEWSLETTER • WINTER 2016