Managing Failed Anti-Reflux Therapy

194 Pages·2006·2.81 MB·English

by  Peter J. Kahrilas

Managing Failed Anti-Reflux Therapy
Mark K. Ferguson and M. Brian Fennerty (Eds)
Managing Failed
Anti-Reflux Therapy
With 76 Illustrations,14 in Full Color
Mark K.Ferguson,MD M.Brian Fennerty,MD
Professor ofSurgery,Head,Thoracic Surgery Professor ofMedicine,Division of
Service,Department ofSurgery,University of Gastroenterology,Department ofMedicine,
Chicago,Chicago,IL,USA Oregon Health & Science University,Portland,
OR,USA
A catalogue record for this book is available from the British Library
Library ofCongress Control Number:2005926816
ISBN 10:1-85233-909-8 Printed on acid-free paper
ISBN 13:978-1-85233-909-8
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Preface
Although GERD was initially described in the early 19thcentury,it is essentially a con-
sequence ofour modern day largesse.Dietary factors and associated obesity have com-
bined with as yet other unknown factors (e.g.a decrease in the prevalence ofH.pylori?)
to make GERD one of the most common diseases affecting western society.It is esti-
mated that up to 20 million adults in the United States suffer from GERD,and treatment
ofthese individuals consumes approximately $10 billion annually,the majority ofit for
prescription drugs used to manage the disease and its symptoms.Fortunately,despite
challenges presented by co-factors resulting in GERD (diet, obesity, etc.), therapy of
GERD is largely successful.However,even a low failure rate for a therapy used in the
management of GERD still results in large numbers of affected patients because of the
high prevalence of this disease.Use of a conservative estimate of a failure rate of 5%
translates to 1 million ineffectively treated and unhappy patients.How to manage these
patients is the subject ofthis book.
Why is publication ofthis book important now? Several factors prompted us to work
on this project.Mature results for proton pump inhibitor use are available,making this
an appropriate time to review outcomes ofPPI therapy ofGERD.Similarly,mature results
are now available for minimally invasive surgical therapy for GERD.In fact,results are
sufficiently promising in the mid-term that some authors are recommending surgery
over PPI use even for patients with only moderate GERD disease.In addition to defining
the success ofthese therapies,the long-term results also illustrate important failure rates
and help define characteristics of patients who are less likely to benefit from conven-
tional treatment options.
Use ofalternative therapies is now becoming quite common,particularly endoscopic
treatments such as bulking agents, radiofrequency therapy, and plication procedures.
The exact role of these modalities in the management of the typical patient with
GERD will be defined in the next few years.A greater challenge is whether and how to
use these techniques for patients who have already failed conventional therapy for
GERD.
Given the complexity ofcauses underlying failures ofGERD therapy,the approach to
managing these patients should be multidisciplinary.For patients who have persistent
GERD symptoms despite aggressive therapy,too often a single therapeutic approach is
used to an extreme without consideration ofalternative modalities,or even whether the
symptoms are actually related to reflux. This may be because of the training, philo-
sophical orientation,or lack of knowledge of the treating physician.To overcome some
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PREFACE
ofthese shortcomings,we felt the time was propitious to produce a book describing man-
agement of medical and surgical failures from both medical and surgical perspectives.
The objectives of this book are to review current medical and surgical management
of GERD,define what constitutes failure of such therapy,and describe approaches to
management ofsuch patients.We have enlisted a group ofauthors whose reputations in
their specialties are universally recognized.Given the widespread incidence of GERD
throughout western society,chapters are written for an international audience.Our goal
was to outline a comprehensive approach to managing failed GERD therapy.However,
ongoing advances in the pharmaceutical, endoscopic, and surgical instrumentation
industries will always make such an effort incomplete.Our hope is that the reader is left
with a framework for approaching these complex patients,and that any new informa-
tion that arises can be fitted into this framework.
Mark K.Ferguson,MD
M.Brian Fennerty,MD
Acknowledgments
The editors would like to thank Eva Senior,our Senior Editorial Assistant,and Melissa
Morton,our Editor,at Springer for their invaluable contributions to this text.
Contents
1. The Epidemiology and Pathophysiology of Gastroesophageal
Reflux Disease
Peter J.Kahrilas and John E.Pandolfino . . . . . . . . . . . . . . . . . . . . . . . 1
2. History of Medical and Surgical Anti-Reflux Therapy
Mark K.Ferguson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3. Medical Management of GERD:Algorithms and Outcomes
David A.Johnson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
4. Complications of GERD:Esophagitis,Stricture,Barrett’s,
and Cancer
John A.Bonino and Prateek Sharma . . . . . . . . . . . . . . . . . . . . . . . . . . 45
5. Principles of Successful Surgical Anti-Reflux Procedures
Federico Cuenca-Abente,Brant K.Oelschlager,and
Carlos A.Pellegrini . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
6. Acute Complications ofAnti-Reflux Surgery
Gianmattia del Genio and Jean-Marie Collard . . . . . . . . . . . . . . . . . . 67
7. Persistent Symptoms after Anti-Reflux Surgery
and their Management
John G.Hunter and M.Brian Fennerty . . . . . . . . . . . . . . . . . . . . . . . . 79
8. Technical Surgical Failures:Presentation,Etiology,and Evaluation
Carrie A.Sims and David W.Rattner . . . . . . . . . . . . . . . . . . . . . . . . . 91
9. Symptoms after Anti-Reflux Surgery:Everything Is Not always
caused by Surgery
Kenneth R.DeVault . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
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CONTENTS
10. The Medical and Endoscopic Management of Failed Surgical
Anti-Reflux Procedures
M.Brian Fennerty and John G.Hunter . . . . . . . . . . . . . . . . . . . . . . . . 113
11. Reoperation for Failed Anti-Reflux Surgery
Jennefer A.Kieran and Myriam J.Curet . . . . . . . . . . . . . . . . . . . . . . . . 127
12. Management ofAlkaline Reflux
Jose M.Clavero,Philippe Topart,and Claude Deschamps . . . . . . . . . . 139
13. Management of the Short Esophagus
Éric Fréchette and André Duranceau . . . . . . . . . . . . . . . . . . . . . . . . . . 151
14. Esophagectomy:Indications,Techniques,and Outcomes
Mark K.Ferguson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
15. Vagal Sparing Esophagectomy
Steven R.DeMeester . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
16. Future Directions of Therapy for GERD
M.Brian Fennerty and Mark K.Ferguson . . . . . . . . . . . . . . . . . . . . . . 181
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Contributors
John A.Bonino,MD André Duranceau,MD
Department ofInternal Medicine,University Department ofSurgery,Université de
ofKansas School ofMedicine,Kansas City, Montréal,Division ofThoracic Surgery,
KS,USA Centre Hospitalier de l’Université de
Montréal,Montréal,Canada
Jose M.Clavero,MD
Division ofGeneral Thoracic Surgery,Mayo
M.Brian Fennerty,MD
Clinic College ofMedicine,Rochester,MN,
Professor ofMedicine,Division of
USA
Gastroenterology,Department ofMedicine,
Oregon Health & Science University,Portland,
Jean-Marie Collard,MD,PhD,FACS,MHon
OR,USA
AFC
Upper Gastrointestinal Surgery Unit,St.Luc
Mark K.Ferguson,MD
Academic Hospital,Louvain Medical School,
Professor ofSurgery,Head,Thoracic Surgery
Brussels,Belgium
Service,Department ofSurgery,University of
Federico Cuenca-Abente,MD Chicago,Chicago,IL,USA
Department ofSurgery,University of
Washington Medical Center,Seattle,WA,USA Éric Fréchette,MD,FRCS
Department ofSurgery,Université de
Myriam J.Curet,MD Montréal,Division ofThoracic Surgery,
Department ofSurgery,Stanford University, Centre Hospitalier de l’Université de
Stanford,CA,USA Montréal,Montréal,Canada
Steven R.DeMeester,MD
Gianmattia del Genio,MD
Department ofSurgery,Keck School of
Upper Gastrointestinal Surgery Unit,St Luc
Medicine,University ofSouthern California,
Academic Hospital,Louvain Medical School,
Los Angeles,CA,USA
Brussels,Belgium
Claude Deschamps,MD
John G.Hunter,MD
Division ofGeneral Thoracic Surgery,Mayo
Department ofSurgery,Oregon Health and
Clinic College ofMedicine,Rochester,MN,
Science University,Portland,OR,USA
USA
Kenneth R.DeVault,MD,FACG David A.Johnson,MD,FACP FACG
Department ofGastroenterology and Department ofGastroenterology,Eastern VA
Hepatology,Mayo Clinic College ofMedicine, School ofMedicine,Digestive and Liver
Jacksonville,FL,USA Diseases,Norfolk,VA,USA
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CONTRIBUTORS
Peter J.Kahrilas,MD David W.Rattner,MD
Division ofGastroenterology,Department of Division ofGeneral and Gastrointestinal Surgery,
Medicine,Northwestern University,Feinberg School Massachusetts General Hospital and Department of
ofMedicine,Chicago,IL,USA Surgery,Harvard Medical School,Boston,MA,USA
Jennefer A.Kieran,MD Prateek Sharma,MD
Department ofSurgery,Stanford University, Division ofGastroenterology and Hepatology,
Stanford,CA,USA University ofKansas School ofMedicine,
Department ofVeterans Affairs Medical Center,
Brant K.Oelschlager,MD Kansas City,MO,USA
Department ofSurgery,University ofWashington
Medical Center,Seattle,WA,USA Carrie A.Sims,MD
Department ofSurgery,Massachusetts General
John E.Pandolfino,MD Hospital,Boston,MA,USA
Division ofGastroenterology,Department of
Medicine,Northwestern University,Feinberg School Philippe Topart,MD
ofMedicine,Chicago,IL,USA Service de Chirurgie Viscérale,Centre Hospitalier
Universitaire,Brest,France
Carlos A.Pellegrini,MD
Department ofSurgery,University ofWashington
Medical Center,Seattle,WA,USA