Beat acid reflux, GERD with Endostim - the new minimally invasive technique

If you have had enough of GERD and can't seem to find a remedy for the discomfort, here is a technology that might just be of aid.

Burning sensation in the throat, regurgitation of bile or undigested food, discomfort while sleeping and a whole bunch of medicines that don't work - if you associate with all these symptoms, you are most likely suffering from acid reflux, GERD. Most people rely on medicines to control the condition, but what does one do when all else fails? Well, today there is a revolutionary medical technique called Endostim that can help. We spoke to Dr Virender K Sharma, a renowned gastroenterologist, chief medical officer of Invive Healthcare Pvt.Ltd, and innovator of the LES Stimulator about this new technology, how it can help and how it can change the lives of people living with GERD.

What is the LES Stimulator?

The LES stimulator is a pacemaker-like machine that helps people suffering from GERD live more comfortably without the acid reflux.

Although it is called acid reflux, these people do not have a problem with the acid in their stomach, they actually make the same potency and amount and acid as other people. In their case it is actually due to a weaker muscle that is known as the lower oesophageal sphincter muscle, and that weakness in the muscle lets the acid get into the wrong places, that is when they have a problem. This sphincter muscle is supposed to prevent the stomach acid from getting into the oesophagus or the food pipe. But due to its weakness it allows this acid to escape, the acid then overwhelms the molecular defenses of the food pipe and these patients start experiencing a burning sensation at the back of their throats and in their chest. In more extreme cases it can cause ulcers, scarring, bleeding and in a few patients it can lead to oesophageal cancer (more in western countries and not so much in India). (Read: Chronic acidity could lead to cancer!)

So far all the medication that has been produced has focused on the acid, since the acid is the worst component of the reflux. But these medicines are not a permanent solution, the patients still have fluid coming up into their throat, wake up in the middle of the night choking and are at the risk of the acid running into their lungs. So, the main problem which is a weak sphincter muscle is not addressed. (Read: Acidity: A cause for heartburn)

Doctors then devised a surgery for this condition, that indirectly tried to create that muscle. It is known as fundoplication. It is where surgeons take a part of the stomach and wrap it around the oeseophagus to create a sort of noose around the area so as to not allow any acid to flow up into the oesophagus. While this works fairly well, over time the body tends to recognize that this is not normal and tries to undo the surgery, and over time the surgery fails. All that really would happen is that the patient would go from suffering from one symptom (acid reflux) to another side effect of the medication or surgery.

The LES stimulator works on the hypothesis that small electrical impulses which is the body's natural way to make muscles work if administered from the outside using a pacemaker, could fix the problem and strengthen the muscle. The benefit of this system is that it is easy, does not produce any collateral effects and works better than other techniques like medication and surgery.

How does this work?

It is like a pacemaker, where we put two tiny electrodes in the esophageal muscles. We then program it to give a particular amount of electrical impulses to the sphincter muscle. We found that if we gave these pulses every three to four hours for about 20 minutes, it helped the sphincter become stronger and stay that way for about four to five hours. The muscle then gradually increases in strength and function.

Who is the best candidate for this implant?

There is a group of patients who do not get any relief from either medicines or lifestyle changes. These patients are very uncomfortable, because for them they are powerless to control this regurgitation of food, bile or stomach acid and it severely affects their everyday lives. That is when they need something more advanced. The other group is those who have had these medications for a long time, and it has taken a toll on their body. Medication to beat acidity has two main side effects one is lowered immunity (where people get infections more often), and the second is that they deplete the stomach's power to absorb nutrients like calcium and iron. So people end up getting anaemia, calcium deficiency and brittle bones. For such patients those who have run out of options to treat the condition this is a good option. (Read: There's more to anaemia than just iron deficiency!)

How is it implanted? What is the basic procedure?

It is a laproscopic procedure that lasts for about 45 minutes and the patient is free to go home the same day. During the procedure the surgeon locates the muscle, and attaches the electrodes to it with small sutures. He then makes a small pocket under the skin, and connects the wires of the electrodes and closes the pocket. The doctor then adjusts the intensity and timing of the pacemaker before the patient is discharged.

What post operative care does the patient have to take?

The patient will have to wear a binder or a band to keep that area pressed, avoid heavy or strenuous exercise, don't life heavy objects and to eat healthy. More importantly he/she will have to observe some diet restrictions for a few days after the procedure.This is mainly to allow the healing around the pocket and the electrodes. The procedure has a very minimal effect on the patients day to day life.

Are there any complications of this surgery and implant?

The procedure is very safe but there are some risks that are common to all pacemaker type implants; like having an infection at the site of the implant (in the pocket), or the wires could get tangled around the intestines and cause a blockage. This is a very rare occurrence, but if it does the patient will require surgery to remove the device and reverse the blockage. In the case of an infection it can be treated with antibiotics, and the surgeon might need to take the old device out and put the new one in.

What kind of care does this implant need?

This therapy lasts for about 12-15 years. So once a patient has this device implanted, he/she will have therapy for a long period. A patient will have a regular post operative check, where the doctor will check all the surgical site (pocket, and incision) for any kind of infection. Then there will be a three month check to see if the patient is responding well to the therapy. (Read: 10 home remedies for acidity that really work!)

Is this available in India?

Yes it is. There are three sites that offer this procedure. One is in Hyderabad, Lucknow, and in Delhi. A patient can visit any of these places for the procedure.

Read more about causes, symptoms, diagnosis and treatment of acidity.

How expensive is it?

Depending on where the patient goes, this procedure costs about three to four lakhs for the entire surgery. Right from the preoperative care, implant and post operative care.