Sutures used to treat acid reflux disease

There are plenty of medications from which to choose for patients with acid reflux disease, but the medications don't work for all patients, while other patients want to eliminate the need to take daily medication.

The gold standard of treatment for gastroesophageal reflux disease is laparoscopic fundoplication, explains Michael S. Nussbaum, MD, interim chairman of the Department of Surgery at the University of Cincinnati. "Laparoscopic fundoplication has a 90% success rate, but not all patients want to undergo surgery if there is another option," he says.

An endoscopic procedure that can be performed on an outpatient basis using minimal sedation is available as a step between treatment with medication and surgery, says Nussbaum. The Plicator procedure (NDO Surgical; Mansfield, MA) offers patients an option to fundoplication, he says.

The Plicator procedure uses small sutures to tighten the opening between the stomach and the esophagus. "The Plicator has proven to be successful in 70% of patients undergoing the procedure," says Gregory Haber, MD, a gastroenterologist at Lenox Hill Hospital in New York City. "This is a simple procedure that can be repeated if necessary and does not prevent fundoplication in the future if needed." Even patients for whom the procedure does not completely eliminate acid reflux do say it improves their day-to-day life, Haber adds.

The typical patient is one whose acid reflux is controllable by medication but who wants to eliminate the cost and need to take medication on a daily basis, says Nussbaum. Contraindications include hiatal hernia that is 2 cm or larger or an upper gastric tract revised by a previous surgery, he says.

Reimbursement often is determined on a case-by-case basis, but more payers are seeing the benefit of eliminating the cost of medication and avoiding the more invasive surgery, says Haber. Nussbaum says that the Plicator procedure also is a useful adjunct to fundoplication for patients who still have some reflux following the surgery. "There is a small subset of patients for whom everything related to surgery is fine, but they still experience some reflux," he explains. The Plicator can be used to tighten up the valve to eliminate the reflux, says Nussbaum.

Although this procedure might not have the same high success rate as fundoplication, Nussbaum points out that many patients appreciate a chance to try the outpatient approach. "Patients are concerned about the long-term effects of taking medication, as well as the risk of infection that accompanies acid suppression," he says. "This is a relatively simple, safe way to eliminate the medication without undergoing major surgery."


For more information about outpatient treatment for gastroesophageal reflux, contact:

  • Michael S. Nussbaum, MD, Interim Chairman, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267. Telephone: (513) 558-4014. E-mail:
  • Gregory Haber, MD, Gastroenterologist, Lenox Hill Hospital, 100 E. 77th St., New York, NY 10021. Telephone: (212) 434-6279. E-mail:

For more information about the Plicator procedure, contact:

  • NDO Surgical, 125 High St., Suite 7, Mansfield, MA 02048. Telephone: (508) 337-8881. Fax: (508) 337-8882. Web: