SAGES - Position Statements and Guidelines
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Enteryx
As Enteryx is already an FDA-approved and coded product, SAGES has
no objection to Boston Scientifics' request to initiate training
programmes, as per their protocol, and to promote and market Enteryx
in South Africa.
There is no specific code at present for this
procedure, but there are other coding structures available for use
by trained and approved interventionists. Those completing their
Enteryx training will have their names made available to the medical
funders.
The role of endoluminal therapies in the management of patients with GORD has
been debated in the editorial pages of prominent journals and at national
meetings. Many physicians have called for larger studies with longer follow-up
and randomised - controlled designs before proceeding with clinical use of
these therapies. Physicians have embraced a particular therapy and use it
clinically in interested patients. We clearly need well-controlled long-term
efficacy studies for these techniques and funding for such ambitious and
expensive products is becoming increasingly difficult. Anecdotally, some
patients respond extremely well to these therapies, while others are not
improved at all.
Endoluminal therapies may fit into the clinical management of patients in
several ways. Their ultimate clinical role will depend on their success rate
and durability of the response. They may be used as primary therapy, reserving
laparoscopic fundoplication for those patients that fail endoluminal therapy.
They may also have a role in the treatment of patients who fail laparoscopic
fundoplication.
Where are we headed? Endoluminal therapies are expected to improve with
long-lasting rapid and even safer procedures available for patients with GORD.
Whether it is one of the currently available technologies or a totally new
modality, endoluminal therapies for GORD will continue to develop.
ENDOSCOPIC TREATMENT PRESENTED AT THE AGA POST-GRADUATE COURSE BY PROFESSOR
GEORGE TRIADAFILOPOULOS OF STANFORD SCHOOL OF MEDICINE:
He compares the various endoscopic techniques that are currently marketed or
been introduced as novel therapies for GORD.
Radio frequency Energy Delivery (STRETTA) is the technique under consideration.
Developed by Curon Medical Inc, Sunnyvale, CA. In South Africa the
introduction, marketing and development is being managed by Perry-Hill
International.
SUMMARY OF THE AGA PRESENTATION
Endoscopic therapies should be considered for patients who respond in part to
PPI, but do not wish to take long-term medication. In addition, possible
candidates are patients who respond partly to PPI, but do not want surgery,
patients who are afraid of possible long-term effects of PPI therapy, patients
with regurgitation not responsive to PPI and who are “not yet ready for
surgery”, patients intolerant to PPI and possibly patients who have failed
fundoplication for GORD.
The best candidates for endoscopic therapies are those who have well
established GORD documented by endoscopy or pH-monitoring and oesophageal
motility studies and have responded to PPI. Other potential candidates are
those with PPI-responsive GORD despite normal twenty four hour pH study
(non-erosive reflux disease - NERD). Consideration should also be given to
patients with PPI-responsive extra-oesophageal manifestations of reflux. The
endoscopic procedures currently available are not appropriate for the late
complications of oesophageal shortening or stricture, poor oesophageal function
and dysphagia.
