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MUSE Procedure for Gastroesophageal Reflux Disease (GERD)
MUSE is one the newest and most advanced anti-reflux procedures currently available. MUSE is currently only available in few centers in the United States. I am honored to be one of the first and most experienced gastroenterologists using MUSE to help patients with GERD. Furthermore, I am delighted to be able to collaborate with the founding engineers behind this revolutionary platform to further advance this technology and contribute to developing minimally invasive techniques to cure GERD rather than subjecting patients to a lifetime medication to treat their symptoms. 

GERD is collection of symptoms and disorders due to reflux of gastric content. Depending on the amount of reflux and the organ most affected (e.g., esophagus, larynx, lungs, sinuses), patients with GERD can experience different signs and symptoms. Heartburn is usually the most common symptom; however, patients with GERD can have no symptoms (silent heartburn) or other symptoms such as regurgitation, chest pain (resembling heart attack), chronic coughing, shortness of breath, hoarseness of the voice and feeling of something stuck in their throat. Also, GERD can cause worsening of other conditions such as asthma, reflux laryngitis (LPR), vocal cord ulcers, subglottic stenosis, tracheal stenosis, and sleep apnea. Untreated chronic GERD can lead to esophageal bleeding, ulceration, narrowing and stricture formation, difficulty swallowing, Barrett’s esophagus (precancerous transformation of the esophageal lining) and esophageal cancer. 

Medications, by decreasing the amount of acid, can help with some symptoms. Unfortunately, besides heartburn, the rest of the symptoms caused by GERD are generally not resolved with medications. Medications do not correct the underlying processes, which is the malfunction of the gastroesophageal valve (the valve between the esophagus and stomach) caused by wear and tear. Patients that start medications generally become dependent on them for the rest of their life. Some patients have intermittent symptoms despite being on medications (breakthrough symptoms). In some cases, the breakthrough symptoms continue to worsen despite medications use due to further worsening of the gastroeophageal valve function. Frequently patients have to increase the dose of their medications to the levels above the recommended dose by the FDA for symptoms relief. 

Symptoms in some patients does not respond to medications (medication non-responders) and some have side effects that prevent them from taking medication. Some patients prefer to suffer from the GERD symptoms due to the fear of adverse reactions associated by taking these medications for long period of time. 

Until recently, there were no safe and relatively user-friendly minimally invasive endoscopic alternative to open surgical procures to repair the gastroesophageal valve. Now with the invention of the MUSE and the FDA clearance of this innovative device, there is once again hope for patients that do not respond to medications, have frequent breakthrough symptoms despite being on medications, cannot tolerate medications or simply do not want to be dependent on such medications for the rest of their lives. 

Advent of MUSE enabled us to endoscopically, without need for open surgery, augment and repair a failing gastroesophageal valve. Patients after MUSE generally can stop their medications completely or take it only on an as-needed basis. Also, reinforcement of the gastroesophageal valve through MUSE, could potentially delay worsening of GERD and delay or stop further weakening of the gastroesophageal valve and progression of the disease. 

MUSE appears to be a resendable first step intervention in patients that are requiring or requesting anti-reflux procedure, considering its safety profile and minimally invasive nature. Chronic bloating (gas-bloat syndrome) and inability to vomit are some of the know side effects associated with surgical anti-reflux procedures. None of these symptoms are reported with MUSE. In addition, in case of failure of the procedure or recurrence of GERD, repeat MUSE for additional reinforcement of the gastroesophageal valve can be done compared to need for repeat surgery in patients that fail surgical anti-reflux intervention. 

MUSE is done at the hospital under sedation with general anesthesia. Patients will be admitted to the hospital post procedure for overnight observation. Sore throat and mild self-limited abdominal discomfort are the most common adverse events. During the first week after the procedure patients remain on soft diet and generally on day 8 resume their normal regular diet. Patients generally can return to normal daily activities 2-3 days after the operation.