Updates on LINX - GERD reflux management system

January 27, 2014 Brian E. Louie, MD

Since my initial LINX blog post 20 months ago, we have been engaged in a dialogue with patients from around the world who suffer from gastroesophageal reflux disease or GERD.  Despite my initial trepidation to “blogging”, this has been a rewarding experience to hear about patient’s problems, their concerns about the current treatments (PPI’s and Nissen fundoplication) and simply interacting with them.  I thank the patients who have taken time to share their thoughts on the blog.

 

When our social media manager asked me to provide an update on LINX, I realized that I have been simply responding to patient’s questions and I haven’t posted any of my thoughts or updates on what is happening with the LINX device.
 
There are some exciting developments for patients who are interesting in having a LINX implanted.

 
Use of MRI and LINX
  • Torax, the company who designed and manufactures the LINX device, has received FDA support for the use of MRI with the LINX device.  This conditional approval allows for patients to undergo and MRI that is 0.7 Tesla or less.   I am trying to clarify with our radiologists what a 0.7 Tesla MRI will cover.
Medicare coverage
 
  • For medicare patients, LINX now has a dedicated procedure code that allows for payment to cover the cost of the hospital portion of implanting the LINX device.  The surgeon’s fee is a separate code and fee and is usually covered.
Insurance update
 
  • For patients with non-medicare insurance, the battle continues.  But, the data from around the country shows that more patients are successful in getting approval for LINX than previously with upwards of 50% being approved.  It is still taking up to 120 days for approval but with more data accruing each month I think insurers are beginning to pay attention.
 
Since the insurance battle has been about lack of data supporting the LINX compared to Nissen, we (Drs. Farivar, Aye and Vallieres) have just completed a study comparing the two devices.  As I write this, I am on my way to the Society for Thoracic Surgeons annual meeting to present our findings, which will hopefully be published in the Annals of Thoracic Surgery later this year.
 
This study shows that LINX and Nissen are the same in terms of treating the patient’s symptoms of GERD, improving the patient’s quality of life and normalizing the level of reflux in the esophagus without the need for PPIs.   However, LINX is a shorter operation, has less complications and results in a more physiologic sphincter since patients are able to belch and have less bloating or gas the Nissen patients.
 
This promises to be an exciting year for patients with reflux.  The addition of LINX to the treatment options for GERD allows us to individualize the treatment.  For patients with large hiatal hernia, Barrett’s esophagus and severe reflux, a Nissen fundoplication performed in an experienced center is still a better option.  But, for patients with a small hiatal hernia who are dependent on PPIs but whose reflux is not well controlled, a LINX device is a great option.
 
Thank you to all the patients who have read and interacted in this blog.  I look forward to reading your posts in the coming year.

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