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teacher man
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Quote teacher man Replybullet Posted: 02 Jan 2015 at 4:55pm
What does your docs say about the LInx vs refundo?
Why not the LInx?
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MrJealousy
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Quote MrJealousy Replybullet Posted: 02 Jan 2015 at 5:03pm
Apparently LINX is not recommended for those that have had a fundo. Plus im allergic to nickel, so it would be no good for me anyway.
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chrisrob
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Quote chrisrob Replybullet Posted: 03 Jan 2015 at 11:29am
Here are my views regarding Linx, for what they're worth. About a year ago, I joined a facebook group devoted to Linx specifically to find out more information.

Out of all the artificial Lower Oesophageal Sphincter strengthening devices and techniques, it is probably the best. However I don't think it's as good as a well performed Laparoscopic Nissen Fundoplication.

I have also learned a considerable amount of how the US health system works which makes me glad we have the NHS.

Acid reflux is a major concern in US and clinics compete for custom by advertising their services. When a clinic starts using a new technique (eg Linx), they get much publicity in local and state press - particularly if it involves a shiny titanium bracelet! (I get Google Alerts of these daily.) The press releases, quoting from Torax medicals own literature, extol the benefits of Linx. Of those eligible for it, it reduces reflux in a large majority with 96% claiming reduction in heartburn symptoms and "A four-week follow-up reduction of ≥50% of proton pump inhibitor (PPI) dose was achieved in over 80% of patients. Self-limiting difficulty in swallowing was found in 70% within four weeks. One patient required for endoscopic dilation. GERD-related quality of life improved significantly." (Modern GERD treatment: feasibility of minimally invasive esophageal sphincter augmentation.) (I think this study was funded by Torax medical.)
The other benefit quoted over LNF is that it is reversible. (Though if it s so good, why would anyone want it undone?) But the "latest technique" doesn't mean it's the best.

Another commonly cited problem of LNF is inability to burp or vomit afterwards. However, the latest figures show this is a problem for fewer than 5% of patients - and a similar number experience this with Linx.

Insufficient data are available on long term results yet but NICE have recently approved its use having previously viewed it as still experimental and permitting its use in a research setting. (Although it can be had privately for around £8000.)
Long term data, however, are available for Laparoscopic Fundoplication as from this study published last month: 20 years later: laparoscopic fundoplication durability. "Long-term results from the early experience with LF are excellent with 94 % of patients reporting only occasional or fewer reflux symptoms at 20-year follow-up. However, 18 % required surgical revision surgery to maintain their results. There is a relatively high rate of daily dysphagia but 90 % of patients are happy to have had LF."

Linx is a "bracelet" of magnetic titanium beads that sits around the lower oesophagus to keep it closed - which is fine if the oesophagus is a smooth tube on the outside (which it isn't). Adverse results reported by recipients on the forum include "pooling" where liquids sit in th eoesophagus unable to pass easily. There have also been one or two patients who have had to have it removed after it caused abrasion damage to the oesophagus.

Further it is not suitable for those with more than 1cm of Barrett's or a large hiatus hernia. And if it's needed, recipients can only undergo MRI scans at low gauss or have it surgically removed first.

As I said at the beginning, I think it's probably the best of the artificial LOS augmentation procedures.
Another which is getting publicity for clinics offering it in US media is Stretta which uses radio frequency via an endoscope to burn the LOS to produce scar tissue restricting the opening. This has been shown to fail in more than one in four recipients within 4 years.
Then there's endoluminal gastroplication (marketed as TIF (Transoral Incisionless Fundoplication, Endostitch, MUSE) whereby a mini stapler on the end of an endoscope folds part of the fundus around the LOS and stitches it.
This report was published in November Transoral Incisionless Fundoplication May Help Refractory GERD, but Doubts Remain "At two years, 66% of patients experienced 50% or greater improvement in GERD health-related quality of life (GERD-HRQL), 70% had a 50% or greater reduction in total regurgitation score, and 65% decreased their reflux symptom index score by 50% or greater." (The study was funded by Endogastric solutions who make TIF.)
One of the BOC trustees, a professor of gastroenterology, had this to say: "During our presentations at DDW over the years I have listened to numerous presentations about different non-surgical techniques, mostly performed by endoscopists in private practice in USA, which purport to be an alternative to laparoscopic fundoplication. Invariably, follow up is short term and relates to symptom improvement only. The few that have performed objective pH studies, report 50% or less who are restored to a physiological pH profile. This appalling level of reflux control may be enough to take the edge off symptoms, but reflux and the risk of Barrett’s and OAC continues. If, as oesophageal surgeons, we had objective control of reflux at these levels, we would be reported to the GMC."

In UK, if NICE find a procedure efficacious and cost effective, they approve it and it becomes available on the NHS. In US, however, where 80% are covered by private insurance (and 20% have no medical cover), if a patient wants a particular treatment they've seen advertised in local media, they expect their insurance to pay for it. One of the biggest causes for concern on the Facebook Linx forum is that it appears to be up to the different insurance companies whether or not they will fund certain procedures with the insurance companies having to fund research into efficacy and cost effectiveness.
One of the members has set up a website here for those who want the Linx procedure but are having battles with their insurance companies to get it funded.
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jcombs99
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Quote jcombs99 Replybullet Posted: 03 Jan 2015 at 1:11pm
     Every American or illegal can go to any hospital and get treatment if it is to save their life but the illegals can't pick their doctor or their hospital after that . We have a few bad doctors and poor hospitals just like you do .But very rich people come here from all over the world for health care ask Mr. Hood from DOWNUNDER . My private ins. covers health care ANYWHERE in the world and yes in the UK too . Just because someone didn't plan for their healthcare like I did why should I pay for them .I got my Fundo in 3 weeks and a Barium X-Ray in 15 minutes and I had the $12 bill when I changed my PPI's in 24 hrs and got them in 3 days .
If I had HGD in Sept. 2008 like I did in the UK I would be DEAD or missing my O ..
   Is $260 per month and I pay the first $250 a year a lot of money I think not . I have better health ins. then my doctor by planning ahead and could careless about cost effectiveness I want great healthcare which I have I have and have been paying for just 40 years .

There a risk to everything you do you are in charge of your healthcare not the PM .

Jeff
      

Edited by jcombs99 - 03 Jan 2015 at 4:56pm
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chrisrob
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Quote chrisrob Replybullet Posted: 04 Jan 2015 at 10:52am
Sorry Jeff,

My post above was not to attack the American health system but merely observations regarding the Linx "band wagon".
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jcombs99
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Quote jcombs99 Replybullet Posted: 04 Jan 2015 at 1:40pm
    I know you didn't there are 70 million on Medicaid (FREE) ins.and now they want to tax my ins. to pay for them . Obama is after to tax the good ins. and the old folks because their really the last ones with anything left.
   Remember they have been doing fundos since 1955 and there is no trouble with cancer so I wonder why Linx is worried about barrets . Can't they sew that thing in place and my doctor does likes Linx. I still like my idea better wireless valve ON or Off simple and I would do it .
Cheers

Edited by jcombs99 - 04 Jan 2015 at 1:42pm
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MrJealousy
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Quote MrJealousy Replybullet Posted: 09 Jan 2015 at 4:00pm
Today I had a consultation with my surgeon, Mr S. Wajed. I am a candidate for corrective NF repair surgery, 3cm type III hiatus hernia, a pH demeester score of 53.23, but a manometry result of around 30mmHg. So I'll be having a 270° wrap called a toupe fundopilcation. I've been put on the waiting list with a date sometime near Easter.
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chrisrob
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Quote chrisrob Replybullet Posted: 10 Jan 2015 at 10:14am
Hope all goes well when you get your operation.
Saj Wajed has a good reputation.
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MrJealousy
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Quote MrJealousy Replybullet Posted: 19 Feb 2015 at 12:54pm
Update, well I'm back on 40mg of esompeprazole. No more heart burn, but the side effects are coming back, parathesis, itching, fatigue, somnolence, bloating and flatulence and arrhythmia. My GP has signed me off work due to the somnolence, I drive for a living. As yet I have no op date, so looks like I'll be off work for the next few months.
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chrisrob
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Quote chrisrob Replybullet Posted: 19 Feb 2015 at 1:08pm
The waiting is the worst bit. But when I see the incredible pressure the surgeons are working under, and totally under-resourced thanks to the cutbacks, I understand.

When I had my revision, it was outside the 18 weeks but I was first on the list that morning. Except an emergency meant a short (possibly life-saving) procedure on another patient had to be done first. Then there wasn't a bed for me. Cutbacks again. If there are empty beds, the hospital isn't working efficiently.
Good luck and hope you get your surgery soon.
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