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jcombs99
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Quote jcombs99 Replybullet Posted: 17áSepá2009 at 8:05pm
How about barrx first then TIF or a fundo after your sure the barrettes is GONE.You don't want to hide barrettes .

HGD JEFF
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egoodman
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Quote egoodman Replybullet Posted: 17áSepá2009 at 8:35pm
Good idea
Are u interested in TIF?
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jcombs99
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Quote jcombs99 Replybullet Posted: 17áSepá2009 at 8:51pm
Nope , my fundo doesn't work but TIF is way to new for me . Fundos been out since 1955 mine didn't work but looking to have it redone .It's 95% the first time and 80% the sceond time and the doctor said there has been thirds .

GOOD LUCK,    HGD JEFF
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twix38
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Quote twix38 Replybullet Posted: 18áSepá2009 at 3:05am
jcoombs99/egoodman,

Makes more sense to me to stop the underlying cause first (TIF/FUNDO) then sort out Barratt's with Barrx and make sure no Barratts left. The other way around means after Barratt's removed it still leaves throat under potential attack by acid whilst throat heals and until TIF/FUNDO can be done resulting in a small chance of returning Barratts, even on medication. Any thoughts?

Would have been nice if egoodman had addressed my earlier question below regarding suitability, histology and existing data for TIF, specifically on patients with Barratts, as it's really coming across like you are simply a salesman. My understanding, as I said, was that Barratts patients were specifically excluded in Dr Fraser's trial and notes? This is rather important to address or you will get no takers and ignoring it is saying a lot, so far??  

"I also understood that the trial by Chris Fraser did not include any Barratt's data and was not currently being taken on for Barratt's. In fact the supporting sheet stated to exclude barratt's as a rule. Has this changed and is TIF now supporting Barratt's patients from sourced trials on TIF with patients who had Barratts??"

Edited by twix38 - 18áSepá2009 at 3:18am
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egoodman
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Quote egoodman Replybullet Posted: 18áSepá2009 at 2:57pm
The experience in the US withTIF is more advanced than in the UK - it has been in clinical practice off trial since 2007. So far, over 1000 cases have been performed in the US.
I cannot comment on the inclusion/exclusion criteria for the St Mark's trial. However, the recommendations of the manufacturer of the Esophyx device in the US is that it can be (and is) performed on Barrett's patients with GORD. With regards to Barrx, the manufacturer of Esophyx is currently in discussions with Barrx Medical talking about developing clinical strategies combining the two procedures - i.e. performing Barrx to ablate the metaplastic mucosa and then performing the TIF to fix the underlying issue of LES incompetence. 
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twix38
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Quote twix38 Replybullet Posted: 18áSepá2009 at 4:27pm
thank you egoodman,

That helps clear up some confusion.

I think I need to see more data from more TIF procedures as I am bound to go on the UK best practice and advice, as exclusion will of course be for a reason, even if only demonstrating caution because it is a relatively new procedure. If it all comes out well with TIF, then a tie up with Barrx sounds like a very exciting proposal for Barratt's sufferers, but too early to tell. Barrx itself still needs further historical data to follow up on and demonstrate (i.e. buried glands 3,4,5 years down the road and suitability for LGD and/or non dysplastic) .

I will keep a look out as this pairing sounds like a potential winner, so long as both practices prove themselves over time with more years to evaluate outcomes.

1,000 is not many at all and how long has the maximum follow up period been to date? I would rather await a minimum of tens of thousands with 3+ years histology data for outcome, comparision, problems etc

Please bear in mind all my above comments are also related to my being non dysplastic in relation to Barratts and the TIF rollout being contra indicated in UK for Barratts for now.

Watching and waiting with interest and hope for a future TIF/Barrx partnership.


Edited by twix38 - 18áSepá2009 at 4:46pm
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