Treatment with reglan has been disappointing in general. Cisapride is a new prokinetic agent an addition to our armamentarium. It has shown some efficacy in GERD treatment remission and is a useful adjunct stage. However, the concerns for toxicity related to heart complications and deaths while taking this drug have essentially forced it out of market. Bleeding obstruction and even malignancy can complicate the matters in the long run.
Perforation is a known complication of the procedure .
During medical therapy, loss of esophageal function can occur which can impair the ability to perform surgery. Drugs also do not improve pre-malignant Barrett's esophagus. Also long term safety of newer potent medications has not been established. Patients are referred often at late stage when surgery has poor results. So what can we do surgically for these pts with GERD especially the ones we cannot treat with drugs and endoscopic interventions.