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GERD treated by IPG

GERD treated by EndoStim’s implantable pulse generator

EndoStim’s IPG is located in a subcutaneous pocket in the anterior abdominal wall and bipolar electrodes are implanted in the LES muscle

Researchers from the Faculty of Medicine at The Chinese University of Hong Kong (CUHK) have successfully implanted pulse generators (IPG) in five patients to restore their lower esophageal sphincter (LES) function, providing a novel treatment option to patients suffering from gastro-oesophageal reflux disease (GERD).

"Medication may not work for some GERD patients and therefore surgical treatment is an alternative for patients with severe symptoms,” said Professor Chiu Wai Yan, Philip, Assistant Dean (External Affairs) of CUHK Faculty of Medicine and Director of the CUHK Jockey Club Minimally Invasive Surgical Skills Centre. “In our research, it appears that the innovative technology is highly effective in controlling symptoms of GERD, while avoiding some of the complications arisen from conventional laparoscopic fundoplication, such as difficulty in swallowing."

Professor Wu Che Yuen Justin (left) and Professor Chiu Wai Yan Philip

The five patients received the EndoStim IPG, which is located in a subcutaneous pocket in the anterior abdominal wall and bipolar electrodes are implanted in the LES muscle.

Implantation is performed using standard laparoscopic techniques - after trocar placement, dissection of fat tissue is performed to expose the muscle wall of the distal oesophagus. In the presence of a small hiatal hernia, repair by caudal retraction of the oesophagus and tightening of the hiatus by standard surgical procedure is indicated.

The bifurcated lead is then introduced into the abdominal cavity and using a guiding needle, the electrodes at the proximal end of the lead are inserted and secured into the oesophageal muscle wall. Upper gastrointestinal endoscopy is performed to identify the Z-line by trans-illumination and to avoid perforation during electrode placement. The distal end of the bipolar lead is retracted through the abdominal wall and connected to the IPG.

After a functionality test of the whole implanted system by the operator, the IPG is then placed into a subcutaneous pocket 3–5cm below the left costal margin. After the anaesthetics have worn off, the IPG is programmed for electrical stimulation therapy. Patients usually stay over in the hospital for one night for observation and are advised to wear an elastic compression bandage over the subcutaneous pocket and the IPG for 10–14 days to prevent formation of a seroma.

The five GERD patients with IPG implanted will be followed up for two years after surgery and so far their reflux symptoms such as heartburn and regurgitation were found to have been significantly reduced, and they no longer need to take the daily GERD medication.

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