A Less Invasive Alternative for GERD

Updated November 22, 2021
Duke esophageal surgeons, Matthew Hartwig, MD and Jacob Klapper, MD

Left to Right: Drs. Matthew Hartwig and Jacob Klapper

When antacids no longer alleviate the burning, belching symptoms of gastroesophageal reflux disease (GERD), an acid reflux procedure performed through the mouth can provide much-needed relief. Duke Health’s Jacob Klapper, MD, and Matthew Hartwig, MD, are among the few esophageal surgeons offering this procedure in North Carolina. “We’re constantly looking for newer, less invasive options to give people freedom from chronic reflux and from taking antacid medications,” Dr. Klapper said.

When to Consider an Acid Reflux Procedure

Antacids and lifestyle changes are often the first line of treatment to alleviate heartburn and the more serious form of acid reflux known as GERD. But taking them for too long can cause other side effects. And they aren’t always effective in stopping food and liquid from rising back up from the stomach. Nor do they repair a weak lower esophageal sphincter, which may be the real culprit. “When the medications are no longer effective or patients are concerned about what they’ve read about these medications, it’s probably time to see a surgeon,” Dr. Klapper said.

Endoscopic Procedure Relieves Reflux

Traditional heartburn operations utilize a surgical fundoplication. Using minimally invasive techniques and small abdominal incisions Drs. Klapper and Hartwig surgically wrap part of the stomach around the lower esophagus to strengthen the lower esophageal sphincter and stop the acid reflux.

The procedure is effective, but people who want relief from GERD symptoms and don’t want to any incisions may opt for an endoscopic procedure that is less invasive but is almost as effective.

The TIF procedure -- TIF stands for transoral incisionless fundoplication -- is performed with an endoscope that is passed through the mouth and into the stomach.  Once inside the stomach, the surgeons use a special device to recreate the esophageal valve that prevents stomach acid from regurgitating into the esophagus.

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As a comprehensive center for the surgical management of reflux, we can offer several solutions if antacids have failed or are no longer effective.

Jacob Klapper, MD

Who Is Eligible for a TIF Procedure?

You may be eligible for the TIF procedure if you:

  • Aren’t getting enough relief from your antacid medication
  • Are concerned about possible side effects of long-term use of antacids
  • Need more than antacid medicine but don’t want to have surgery

Dr. Klapper said people with small hernias may be eligible candidates. Larger hernias will need to be repaired first.

If You Have GERD, Seek Care at a Specialized Esophageal Disorders Clinic

Drs. Klapper and Hartwig are part of a highly specialized esophageal clinic at Duke that brings together gastroenterologists and thoracic surgeons to provide the full spectrum of care for people with esophageal disorders such as GERD, swallowing disorders such as esophageal dysphagia, and esophageal motility disorders such as achalasia. This gives you the opportunity to discuss your esophageal problems with medical and surgical specialists during the same visit. They provide comprehensive management of these disorders and offer a range of treatments that are not always widely available at smaller hospitals. 

It’s important for people to seek out a specialized esophageal clinic like Duke’s because, Dr. Klapper said, there isn’t just one treatment approach to GERD that’s suitable for everyone. “As a comprehensive center for the surgical management of reflux, we can offer several solutions if antacids have failed or are no longer effective. We tailor our approach to everyone’s needs.” The major advantage TIF has over these other therapies is that it’s incisionless and can be done as an outpatient procedure, he said.

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