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This prospective, multicenter, single-arm study evaluated the safety and efficacy of the endoscopic implantation of Enteryx, a biocompatible, non-biodegradable liquid polymer for the treatment of GERD.Eighty-five patients with heartburn symptoms responsive to proton pump inhibitor (PPI) use were enrolled. Inclusion requirements were HRQL scoreor = 11 on PPI andor = 20 off PPI, and 24-hour PH probe withor = 5% total time at PHor = 4. Patients with a hiatus hernia3 cm, grade 3 or 4 esophagitis, or esophageal motility disorder were excluded. Using a 4-mm needle tipped catheter during standard endoscopy, implants were made in 3-4 quadrants deep into the wall of the cardia. Use of PPI medications, pH-metry, manometry, GERD symptoms, and patient quality of life were assessed over a 6-month follow-up period.At 6 months, PPI use was eliminated in 74% and reduced by50% in 10% of patients. The median HRQL score improved from 24.0 pre-implant (baseline off PPIs) to 4.0 at 6 months (p0.001). Mean total esophageal acid exposure time was 9.5% pretherapy and 6.7% at 6 months (p0.001). Mean LES length increased from 2.0 cm at baseline to 3.0 cm posttherapy (p = 0.003). There were no clinically serious adverse events. Transient mild-to-moderate chest pain commonly occurred after implantation.The endoscopic implantation of Enteryx is a safe and effective therapy for eliminating or decreasing the need for PPI medications, improving GERD symptoms and patient quality of life, and decreasing esophageal acid exposure among patients suffering from GERD.

Specialty practice in general, and gastroenterology in particular, is undergoing significant transformation as we head into the new millennium. Gastroenterologists will need to adapt to the continued evolution and consolidation of managed care. Among other issues, gastroenterologists will need strategies for dealing with pricing pressures, changing technology, increased consumerism, a perceived specialist oversupply, and a rapidly aging population. These and other developments will drive a myriad of physician responses in an effort to confront changing practice realities.

To the Editor: The recent opinion piece by Konda and Waxman (1) regarding endotherapy for Barrett's esophagus misstates the AGA Medical Position Statement (2) on the management of Barrett's and requires correction. Konda writes that the AGA statement does not recommend endotherapy for Barrett's non-dysplasia or low-grade dysplasia, but erroneously cites the text. On page 1089, the Position statement clearly states that “radiofrequency ablation should also be a therapeutic option for treatment of patients with confirmed low-grade dysplasia,” and select individuals with non-dysplastic Barrett's who are judged to be at increased risk for progression to high-grade dysplasia or cancer.