Minimally invasive procedure helps children with GERD

July 16, 2003

A new minimally invasive procedure is helping children suffering from gastroesophageal reflux disease (GERD), a cause of chronic heartburn. In the Chicago area, the procedure is being performed only at the University of Chicago Children's Hospital (UCCH).

In patients with GERD, fluids from the stomach splash back into the esophagus due to a weakened valve at the stomach's opening. The reflux causes irritation and pain in the esophagus. Left untreated, the condition could lead to esophagitis and even esophageal cancer.

"GERD in infants and children is occurring in almost epidemic proportions," said Donald Liu, MD, PhD, chief of pediatric surgery at UCCH, "although it's not understood why." Several thousand children in America are diagnosed with the disease each year.

Now, a minimally invasive surgical treatment is available. The Stretta System makes this surgery a one-hour, outpatient procedure. Most patients resume normal activities the following day.

A tiny video camera is lowered through the mouth along with the Stretta catheter. The catheter emits radiofrequency energy, which narrows the opening in the area where the esophagus meets the stomach. A tighter valve in the gastroesophageal junction prevents reflux.

Studies have shown that within six months after the procedure, the amount of acid found in a patient's esophagus has been cut by more than half. Several medical and surgical journals have reported no symptoms in up to 80 percent of patients within a three-year period.

Traditional surgery for GERD would involve a large incision in the patient's upper abdomen to reconfigure the esophagus and stomach anatomy to prevent acid reflux. Patients would have to stay in the hospital for several days to weeks as they recover from the surgery.

The Stretta procedure is one of a number of minimally invasive surgeries preformed at UCCH. Patients deemed unsuitable for Stretta become candidates for laparoscopic Nissen Fundoplication, which is performed through "tiny keyhole" incisions. Patients typically are discharged from the hospital less than two days after surgery. Liu performs nearly 100 such procedures on children annually at UCCH.

"Due to the nature of MIS and improved cosmetics, I believe pediatricians will be more willing to consider and recommend surgical intervention," Liu said. "Likewise, patients and their parents will seek the procedure at an earlier age."

Many GERD patients can avoid surgery altogether through lifestyle modifications such as avoiding spicy foods or not eating before bedtime. Over-the-counter and prescription medications can help, but not for all patients. The Stretta procedure is significantly less expensive than lifetime medication. It's also one-fifth the cost of traditional surgery.

Liu believes the concept of avoiding large incisions to perform invasive surgery and causing less post-operative pain are the basis for the current surge of minimally invasive surgery in children.

The Stretta procedure requires no incisions. The FDA approved the technique for adults in 2000 and for the teenage population late last year.

Liu also performs MIS for:

Pyloric stenosis: a disease in which the muscle between the stomach and small bowel becomes enlarged, causing vomiting and dehydration.
Pectus excavatum: more commonly known as funnel chest.
Inflammatory bowel disease: such as Crohn's disease and ulcerative colitis
Tumor resection
Lung biopsies
Myasthenia gravis: muscle weakness due to an autoimmune attack
Pulmonary infections

"Soon all surgery will be done this way," Liu predicted.