Endoscopic Sphincter Augmentation (ESA)

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Nearly a third of the adults in the United States experience issues with heartburn or acid reflux on a weekly basis. Some of these individuals are suffering from gastroesophageal reflux disease (GERD) which is chronic acid reflux that does not respond to medication or lifestyle changes. GERD is normally a symptom of a weak esophageal sphincter, a hiatal hernia, or both and will require surgical intervention. The surgical procedures used to repair these causes of GERD are called antireflux procedures.

What Is GERD?

GERD or gastroesophageal reflux disease is a disorder that causes some acidic stomach juices to travel up into the esophagus. This can cause a burning sensation in the throat, chest, or neck and can lead to damage to the esophagus if left untreated.

What Causes Gerd?

GERD can happen occasionally and be temporary or it can be a chronic everyday occurrence. Individuals who experience chronic GERD are usually suffering from issues with their LES or a hiatal hernia.

Lower esophageal sphincter (LES)

The food we eat travels from our mouths down into the stomach through a long tube known as the esophagus. At the point where the stomach connects to the esophagus is a small ring-like muscle (lower esophageal sphincter LES) that opens to let food pass and then closes to keep the food in the stomach to be digested. When this valve does not work properly and remains open too long or will not close, it allows acid from the stomach to back-flow into the esophagus.

Hiatal hernia

What Is a Hiatal Hernia? IBI Healthcare Institute

Call and speak to our physicians about laparoscopic Nissen fundoplication and/or hiatal hernia repair. They can help you with your GERD.

Another issue that can cause GERD is a hiatal hernia. The diaphragm naturally has a small hole for the top portion of the stomach to pass through located at the connection point to the esophagus. If this hole is stretched enough, it can allow the stomach to migrate upward through the diaphragm. Shifting even a few centimeters can cause symptoms of GERD.

Many people experience temporary GERD which is usually caused by:

Certain medications can cause GERD
Wearing clothing that is too tight
Overeating resulting a very full stomach
Smoking or consuming alcohol
Consuming foods with high-fat content
Eating spicy foods
Vigorous exercise

What Happens If GERD Is Left Untreated?

The lining inside the esophagus will become irritated, inflamed, and eventually damaged which can result in:

Narrowing of the esophagus

Stomach acid can cause scar tissue to build up and gradually narrow the size of the esophagus which can make it difficult to swallow food.

Esophageal ulcer

The acid from the stomach can erode the esophageal tissue and create an open sore causing pain, bleeding and difficulty swallowing.

Increased risk of esophageal cancer

Repeated exposure to harsh stomach acid can cause the cells in the lower esophagus to change and lead to a condition called “Barrett’s esophagus” which can eventually become cancerous.

What Is The Treatment For Chronic GERD?

Endoscopic sphincter augmentation is a new, minimally invasive and effective endoscopic procedure for treating GERD when medication and lifestyle choices have not been effective.

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Making the necessary repairs to treat GERD often requires two procedures, the first to improve the function of the lower esophageal muscle.
The typical steps involved are:
1. Anesthesia is administered to the patient and positioning is completed.
2. The surgeon inserts the endoscope through the mouth into the lower esophagus. Without incisions.
3. The endoscopic is a small thin flexible tube that bears a suturing device. This is used to pass sutures into the LES therebytighening it.
4. Secured with sutures, this will support and tighten the sphincter muscle.
5. The endoscope is then removed.
Fig. 1
Fig. 1 Antegrade view of the gastroesophageal junction before endoscopic augmentation.
Fig. 2
Fig. 2 Retroflexed view of the cardia before endoscopic augmentation. A diaphragmatic hiatus is noted.
Fig. 3
Fig. 3 A simple interrupted suture was placed from 12 o’clock to 3 o’clock of the gastroesophageal junction using a double channel therapeutic scope affixed with the Apollo OverStitch device. This was followed by another suture from 3 o’clock to 6 o’clock with reinforcement as needed in order to reduce the width of the gastroesophageal junction.
Fig. 4
Fig. 4 Antegrade view of the gastroesophageal junction after completion of the endoscopic augmentation.
ESA - Fig. 5
Fig. 5 Retroflexed view of the cardia after completion of the endoscopic augmentation. There was no hiatus between the gastroscope and the gastroesophageal junction.

Who Is A Candidate For Endoscopic Sphincter Augmentation?

Patients of any age who have chronic acid reflux that has been unresponsive to alternative non-invasive treatments may be a candidate for endoscopic sphincter augmentation.

What Are The Benefits Of Endoscopic Sphincter Augmentation?

  • Endoscopic procedures carries fewer risks;
  • Excellent results – 95% success rate;
  • Very little pain associated with recovery;
  • same day procedure;
  • Performed through only a few small incisions;
  • Recovery time is faster.

What Are The Risks Of Endoscopic Sphincter Augmentation?

Endoscopic procedures generally carries fewer risks than surgery and is associated with less pain and quicker recovery times however, as with any surgical procedure there are associated risks which may include the risk of negative reaction to general anesthesia, bleeding, infection, and injury to internal organs.

How Much does Endoscopic Sphincter Augmentation Cost?

The cost of the surgery to treat GERD will depend on which procedures are being performed, the presence of a hiatal hernia, the extent of the repairs necessary, the use of mesh, etc. Feel free to check for a pricing estimate using our price checker tool.

Take the first step on your journey to a healthy life

IBI Healthcare Institute provides an unmatched patient experience and outstanding results. You matter to us.

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