Heartburn and reflux

Most people experience heartburn from time to time. The discomfort often is described as a burning sensation in the upper and mid chest that worsens when lying down. While heartburn can be caused by spicy food, alcohol or overeating, it also can be a symptom of an underlying condition.

If you suffer from heartburn more than twice a week, you may have GERD. The condition occurs when the barrier between the esophagus and stomach is weakened, and stomach acid flows back into the esophagus. Left untreated, it can lead to more serious conditions such as ulcers, scarring and even esophageal cancer.

Laparoscopic, robotic and endoscopic anti-reflux treatments

We offer a variety of treatments for acid reflux, many of which are performed using minimally invasive techniques to keep you safe and aid in your fast recovery.

Some of the surgeries we offer include:

• Hiatal hernia repair: Many GERD patients have hiatal hernias, which occur when the upper stomach pushes through diaphragm muscle. Repair of a hiatal hernia involves moving the herniated portion of the stomach back into place, reinforcing the valve and closing the hole in the diaphragm muscle. Often performed as an outpatient surgery, our team is highly experienced in performing this procedure using minimally invasive techniques.
• Fundoplication: Also a laparoscopic (minimally invasive) surgery, a fundoplication is performed by wrapping a portion of the stomach around the LES to make it stronger, preventing the reflux of stomach acid.
• Insertion of magnetic devices for reflux: During this minimally invasive procedure, a small metallic "bracelet" is placed around the lower esophagus to prevent reflux of stomach acid into the esophagus.
• Transoral incisionless fundoplication (TIF): This nonsurgical procedure is performed through the mouth and no incision is necessary. A flexible tube (endoscope) is placed through the mouth into the stomach. A device is passed through the mouth and allows the surgeon to reshape and reinforce the LES.
• Radiofrequency reconstruction of the esophagus: During this endoscopic procedure, the LES is stimulated using radiofrequency energy, which strengthens the valve without harming surrounding tissue.

In addition to acid reflux and GERD, we also treat a number of conditions affecting the esophagus, including:

• Achalasia: Sometimes described as the 'opposite of GERD,' Achalasia is a swallowing disorder in which food and liquid are prevented from passing into the stomach. Achalasia is the result of damage to the nerves in the esophagus, which prevent it from squeezing food into the stomach.
• Barrett's esophagus: Patients with this condition have changes in the cells of their esophageal linings. These changes raise the risk of developing esophageal cancer. One in five patients with chronic GERD have undiagnosed Barrett's esophagus.
• Difficulty swallowing: Also called dysphagia, swallowing difficulties can be caused by a variety of conditions including nervous system and brain disorders, muscle disorders, esophageal narrowing and blockages, scarring from acid reflux, food allergies and infection.
• Inlet patches: Inlet patches are flat red or pink velvety areas found in the upper esophagus. Often these abnormalities develop without symptoms but are found during an endoscopy.
• Zenker's diverticulum: Zenker's diverticulum is the development of a pouch in the back of the throat at the beginning of the digestive tract. Food and salvia can become trapped here and the patient has difficulty swallowing.

Surgery to treat esophageal conditions

We perform laparoscopic, endoscopic and robot-assisted surgeries to treat conditions of the esophagus. These procedures include:

• Heller myotomy: A laparoscopic surgery, Heller myotomy is performed through small incisions in the abdomen to treat achalasia and difficulty swallowing. Muscles in the lower esophagus are cut, relieving tension and allowing food and fluid to enter the stomach without difficulty.
• POEM (peroral endoscopic myotomy): Like the Heller myotomy, this procedure is performed to create small incisions in the esophagus that relax the muscles to allow food and fluid to enter the stomach without difficulty. However, instead of through small incisions in the abdomen, this procedure is performed through the mouth.
• Cricopharyngeal myotomy: A treatment for Zenker's diverticulum, this procedure is performed through the mouth. Using an endoscope, the surgeon makes incisions in the muscle at the top of the esophagus to improve swallowing.
• Esophageal dilation: Performed endoscopically (through the mouth), the esophagus is stretched using instruments such as a balloon dilator, guided wire or bougies. This procedure is used to treat achalasia, peptic stricture, Schatzki's ring and eosinophilic esophagitis.
• Radiofrequency ablation: Used to treat Barrett's esophagus or inlet patches, this endoscopic procedure uses radiofrequency waves to burn abnormal cell growth.

Gastroparesis is a condition in which the stomach's normal emptying is interrupted. Those with the condition often feel full quickly after eating, and experience heartburn, nausea, weight loss, belching and bloating. Our treatments for gastroparesis include:

• Gastric peroral endoscopic myotomy (G-POEM) or peroral endoscopic pyloromyotomy (POP): This procedure is endoscopic, so no incisions are made on the skin. Instead, an endoscope is inserted through the mouth. Tools used through the endoscope are used to make an incision in the muscles near the intersection of the stomach and small intestine. This allows the muscles to relax and allow food to move through properly.
• Neurostimulation: Sometimes called a 'gastric pacemaker,' this procedure involves implanting a small device beneath the skin in the lower abdomen. The device emits mild electrical pulses that treat nausea and vomiting related to gastroparesis.
• Pyloroplasty: This minimally invasive surgery is performed to reconfigure and open the valve at the end of the stomach.
• G-tube/J-tube: A G-tube is placed into the stomach and a J-tube is placed in the small bowel. These tubes are used to provide nutrition directly into the body when patients are unable to take in adequate nutrition through a normal diet. The procedures to place the tubes can be performed endoscopically or laparoscopically.
• Gastrectomy: This stomach removal surgery is done laparoscopically for end-stage gastroparesis. All but a small pouch of the stomach is removed. Patients then must follow a strict diet and maintain regular follow-ups to ensure adequate nutrition.

In partnership with the Sarah Cannon Cancer Institute and our oncology program, our team provides surgical and endoscopic treatments for esophageal and gastric cancers. These procedures include:

• Esophageal submucosal dissection (ESD) or Esophageal mucosal resection (EMR): During this procedure, our team uses an endoscope to remove abnormal cells, which are sent to pathology for evaluation.
• Esophagectomy (esophagus removal): A laparoscopic procedure, esophagectomy is performed to remove the esophagus and lymph nodes as part of cancer treatment.
• Gastrectomy (stomach removal): A laparoscopic procedure, gastrectomy may be performed to remove the cancerous portion of the stomach. All or part of the stomach and the lymph nodes may be removed.

Our surgeons are also experienced in providing exceptional care for those in need of general surgery procedures, including:

• Appendectomy (appendix removal): Patients with inflammation or rupture of the appendix may need to have it removed via minimally invasive techniques.
• Cholecystectomy (gallbladder removal): Patients who are experiencing gallstones, gallbladder inflammation or pain related to the gallbladder may benefit from laparoscopic removal of the gallbladder.
• Colon resection: During this procedure, our team removes a small portion of the bowel to treat diverticulitis/diverticulosis, obstruction of the bowel, or twisting of the bowel. This procedure is performed using minimally invasive techniques.
• Inguinal hernia repair: We perform these hernia repairs in the groin area using open and minimally invasive approaches. Mesh is sometimes used to help close the hernia.
• Ventral/umbilical hernia repair: These abdominal hernias can be repaired using open or minimally invasive techniques, depending on the patient's needs. Mesh may be used to help close the hernia.