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rafael
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Quote rafael Replybullet Topic: Understanding the options - barrett
    Posted: 15 Aug 2018 at 4:05pm
Hi, I was diagnosed with barrett's esophagus without dysplasia some months ago (I'm 34 yrs old). Since that, I have been reviewing and reading about alternatives to reflux or the metaplasia. I found some recently news about barrett regression.

linx and barrett

regression barrett


anyone has tried with linx?

Regards

Rafael
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steveb8189
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Quote steveb8189 Replybullet Posted: 15 Aug 2018 at 9:30pm
I was 34 when diagnosed too - welcome to the group!

Sorry, I can't help with first hand experience of Linx but it is something I've considered. There are certainly benefits that it is fully reversible but I would have concerns about having a foreign body inside me permanently. There is also some concern over the possibility to doing damage to the outside wall of the esophagus which doesn't sound like fun.

I haven't read the article behind the youtube video but I got a bit confused at 2:04 when they said Barrett's esophagus was one of the exclusion criteria and then went on to examine people with IM (which is BO..)
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chrisrob
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Quote chrisrob Replybullet Posted: 15 Aug 2018 at 10:45pm
Hi Rafael and welcome,

I have previously seen the paper referred to here which was presented at the SAGES conference last year but I am highly sceptical of the findings.

Barrett's metaplasia is a development of columnar cells lining the lower oesophagus to protect against erosion from acid and bile combination. The latest thoughts are that the columnar cells are generated from gastric stem cells. As such, they are permanent: Barrett's does not go away. There are many reasons why it may appear to recede, the most common being, the measurements of the lesion are extremely difficult to make. The endoscopist has to judge by the markings every 5 cm along the outside of the endoscope. The oesophagus tube is stretchy (a bit like a bicycle inner tube) and gets pulled and pushed by the scope.
It is also quite common for a new mucosal layer of squamous cells to form over the top of the Barrett's cells.

The Linx magnetic sphincter augmentation device reduces reflux; it is not a device to reduce Barrett's.

My personal views of Linx are described below where I've compared it to the gold standard Laparoscopic Nissen fundoplication.

LINX pros:
Its ring of magnetic beads help close the lower oesophageal sphincter.
The surgery for this is slightly less invasive and slightly shorter than for LNF and there is less (internal) healing for the body to do. It has been available for nearly 15 years. The operation is minimal and patients can go home the next day with some able to go home the same day. You can eat normally afterwards.
If it doesn't work or goes wrong, it can be removed and LNF performed instead.
A "long term" study over 6 years (with a mean implantation time of 3 years) of 100 recipients showed 85% of them no longer required daily PPIs for acid reflux and were glad they had had the procedure.
LINX cons:
It costs over twice as much as LNF.
It cannot be used in everybody (depends on presence of Barrett's and hiatus hernia). It doesn't repair a hiatus hernia.
If needed, MRI scans can only be at low power. MRI can displace magnets or create induction heating.
63% of recipients experience swallowing difficulties. A solid enough bolus propelled with sufficient peristalsis is required to open the device.
LINX unknowns:
Will it migrate or erode the adventia (outer wall of oesophagus) over time? 40 years ago, a new device was being enthusiastically embraced. Angelchik was effectively a broad gel rubber band / collar attached around the oesophagus that kept the oesophagus closed by elasticity. However over a long period, it's movement against the adventia caused gradual erosion. Migration and erosion issues occurred causing a clamour of patients having it removed.
LNF pros:
It is the gold standard for reflux reduction surgery.
Nissen fundoplications have been used for 60 years with surgeons becoming more expert and techniques improving all the time. It has been performed laparoscopically for over 20 years.
The operation is minimal with patients usually able to go home the next day (and some on the same day as their operation).
It uses natural body tissue with similar elasticity to the organ it surrounds.
A recent study of nearly 200 patients who had LNF 20 years ago found 94% satisfaction with it.
There is no risk of erosion or migration.
Any hiatus hernia will be corrected and the Nissen wrap prevents it from recurring.
It can be performed if the patient has Barrett's.
LNF cons:
85% of patients experience problems with burping or vomitting whilst the scar tissue heals.
50% of patients have swallowing difficulties while the scar tissue heals. Soft foods are required at first but you can eat normally within a few weeks.
In the 20 year study, the wrap had failed in 18% of patients, when it can be redone. (Newer techniques mean that failure rates are now estimated to be only around 5%.)
NHS is far more likely to provide Nissen. LINX is too expensive.

Linx may look shiny and sexy but you don't see it once implanted - and it was originally developed for faecal incontinence - the Fenix device.
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rafael
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Quote rafael Replybullet Posted: 17 Aug 2018 at 12:49am
thanks for the information and for the welcome

I know RFA ablaltion is not usually recomended in Barrett without dysplasia, mainly because it hasn't a good relation between cost and effectiveness (taken into account the probabilities) but, would u recomend it just to decrease the risk of any future problem? do u know how effective it would be?



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chrisrob
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Quote chrisrob Replybullet Posted: 17 Aug 2018 at 8:36am
RFA isn't recommended for non-dysplastic Barrett's because the risks of damage to the oesophagus (eg perforation) from the probe are probably greater than the risks of progression to cancer.

Although ablation can remove all traces of traces of Barrett's (Complete Eradication of Intestinal Metaplasia, or CEIM), the fact you developed Barrett's previously means you are quite likely to develop it again.

Following RFA, patients still have to have regular surveillance scopes & take PPI medication as before to reduce risk of recurrence.
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