New Incisionless Device to Correct Reflux by Medigus

A new trans-oral incisionless device to surgically treat reflux was announced by Medigus, an Israeli company, called the "SRS system." It is a competitor to two other incisionless devices currently available: Stretta (Mederi Therapeutics) and Esophyx (Endogastric Solutions).

Common to all incisionless devices is the fact that the procedure is performed using an endoscope introduced through the mouth threaded down into the stomach. At this point, the technique used by the devices to tighten the valve separating the esophagus and stomach varies.

With Stretta (first on the market), radiofrequency energy is used to induce scarring of the valve causing it to constrict.

With Esophyx (next to market), a 270 degree 2-3cm fundoplication is performed by manipulating the esophago-gastric tissue in a rotating twisting manner and anchoring in place using 12 or more full-thickness polypropylene fasteners.

With SRS, the stomach is folded up against the esophagus and anchored in place using a few staplers. Watch the video below to see how this system works.

The technique that is best for a given patient will vary based on surgeon's comfort and experience with the device as well as unique patient variables. As such, no technique is perfect or applicable to everybody. Also, only time will tell if this or any other incisonless technique provides long-term reflux relief with minimal risk and side effects.

Ask your GI or general surgery specialist on what option is best for you.

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New Video on Treatment of Hyper-Nasal Speech by Injection

Our office has created a new video that we have uploaded that shows how hyper-nasal speech can be corrected via injection of filler agents under endoscopic guidance.

Keep in mind that this procedure ONLY works with small velopharyngeal insufficiency.

Hyper-nasal speech occurs when there is too much nasal airflow during speech as opposed to hypo-nasal speech (ie, nasal obstruction) which occurs when there is little or no nasal airflow during speech. In either case, the voice sounds "nasal".

Check out the video here.

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Breathing or Voice... You Can Only Have One...

Sounds like a choice taken out of a morbid horror movie...

"You can ONLY have one... Your voice or your breath..."

The victim than loses one or the other after making a choice getting either the tongue or head cut off with a knife.

But patients with vocal cord paralysis on both sides are essentially faced with this very question.

Normally, the vocal cords (TVC in picture below) found in the voicebox move to accommodate talking or breathing.

When the vocal cords are apart, breathing occurs allowing air to pass unimpeded between the vocal cords and down into the lungs. However, with talking, the vocal cords come together tightly and vibrate creating voice. Watch a movie.

However, when both vocal cords become paralyzed, they neither move apart to help with breathing nor come together to assist with talking. Indeed, the voice and breathing BOTH stink.

It is in just this situation that the choice of breathing or voice becomes important because a patient can not have both. Improving one will sacrifice the other.

To explain this connection of voice and breathing further, normally, when the vocal cords are both moving fine, the voice is at 100% and breathing is at 100%. However, with bilateral paralysis, the voice and breathing are now linked to each other and collectively can not exceed 100%. As such, a patient with new onset bilateral vocal cord paralysis may start with a 40% of normal vocal quality and 60% of normal breathing ability for a total of 100%.

Using this scenario as a starting point where vocal quality is at 40% and breathing is at 60% of normal...

If a patient chooses to improve the vocal quality from 40% to 100% (an improvement of 60%), then breathing WILL correspondingly decrease 60% down to 0%... and potentially die given the ability to breathe is lost. Why? Because the vocal cords can be surgically forced together to allow for voice... but given the vocal cords are paralyzed, they can not move back apart to allow for breathing.


If a patient chooses to improve breathing quality from 60% to 100% (an improvement of 40%),  then the vocal quality WILL correspondingly decrease 40% down to 0%... and lose the ability to talk. Why? Because the vocal cords can be surgically forced apart to allow for breathing... but given the vocal cords are paralyzed, they can not move back together to allow for vocal cord vibration.


The total percentage of vocal and breathing quality can never be more than 100%. If a patient wants the best possibly voice and breathing, than a compromise would be to increase the vocal quality 10% from 40% to 50%, but understanding that this 10% improvement in vocal quality WILL mean a corresponding 10% decrease in breathing ability from 60% to 50%. This 10% change means that in the end, the voice and breathing would both end up at 50% of normal.

In most cases of bilateral vocal cord paralysis, it is the reduced breathing and shortness of breath that bothers people the most. The voice isn't good, but when given the choice, most people choose to try and improve their breathing ability understanding their voice may further deteriorate.

To read more about such treatment options, click here.

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New Minimally Invasive Technique to Treat Tonsil Stones Developed by Dr. Chang

Dr. Chang developed an innovative minimally invasive technique to treat tonsil stones using coblation technology. His findings have been published in this month's ENT Journal. In fact, his research made the front cover of the journal! Dr. Richard Thrasher of ENT Centers of Texas was a co-author in the study.

This technique called coblation tonsil cryptolysis is unique in that it can be performed in adult patients without sedation using only local anesthesia, much like laser tonsil cryptolysis. As with laser cryptolysis, pain is significant for only a few days and most adults can resume normal diet and activity within 1 week. In contrast, tonsillectomy entails significant morbidity for several weeks. However, coblation avoids the significant disadvantages of laser use, including the potential for airway fire, retinal damage from reflected scatter, dealing with plume from vaporized tissues, oral/facial burns, and the high cost of purchasing and maintaining laser equipment. After a single session of coblation tonsil cryptolysis, a significant decrease and even elimination of tonsil stones can potentially be achieved.

Read more about this mode of treatment here.

Read the research article here.

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Video on Zenker's Diverticulum Surgery (Endoscopic Staple Diverticulostomy)

Our office has produced a new video describing Endoscopic Staple Diverticulostomy to treat Zenker's Diverticulum.

We have the unusual honor of having treated patients throughout the United States for this rare condition. Patients we have successfully treated have come from as far away as Oregon, New York, Florida, Pennsylvania, Louisiana, Arizona, etc.

For more information, please visit us here.

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In-Office Sinus Surgery Without General Anesthesia

There has been tremendous advances in sinus surgery over the past decade. From the elimination of nasal packing after most routine sinus surgery to the more recent use of balloons to open the sinus cavities, patient comfort has improved greatly after this particular operation. What used to be a several week recovery may now only be a few days.

Balloon sinuplasty in particular has been revolutionary in the surgical treatment of chronic sinusitis. Though sinus surgery normally is performed under general anesthesia, balloon sinuplasty now allows this operation to be performed awake WITHOUT sedation using local anesthesia only.

At its essence, sinus surgery "opens" up blocked sinus cavities to allow drainage and ventilation. Traditional sinus surgery "removes" tissue to accomplish this goal whereas balloon sinuplasty stretches open the sinus cavity without the need for tissue removal.

Given the lack of tissue removal with balloon sinuplasty, there is less pain and faster recovery after the procedure.

What are the steps?

After adequate anesthesia of the nose using both topical and injectable numbing medicine... Step 1 Under endoscopic guidance, the balloon catheter is introduced into the nasal cavity and guided towards the target sinus cavity opening. Depending on the system used, a sinus guidewire or sinus illumination may be used to help with the guidance.
Step 2 Once the sinus balloon catheter is correctly positioned across the blocked sinus opening, the balloon is gradually inflated to stretch open the ostia.
Step 3 After several seconds, the sinus balloon catheter is then deflated and removed leaving an enlarged sinus opening allowing for the return of sinus drainage. There is little to no disruption to mucosal lining.

Of course, not all patients are candidates for balloon sinuplasty, let alone this procedure to be done awake with local anesthesia alone.

In particular, balloon sinuplasty can only address blockages involving the frontal, maxillary, and sphenoid sinus cavities. Ethmoid sinus cavities can NOT be corrected using this method.

Also, balloon sinuplasty does not allow for tissue biopsies (by definition, the advantage of balloon sinuplasty is the lack of need to remove any sinus or nasal tissues). As such, if there are any masses present including nasal polyps, traditional sinus surgery is the better way to go.

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