In Reply.—Dr Angelchik makes several interesting but unsubstantiated claims in his letter: "The technical question is critical." "If the surgeon is overly aggressive in mobilizing the esophagus, the device will slide up and down, leading to reflux when it ascends above the reconstituted lower esophageal high-pressure zone or dysphagia when it descends below the gastric cardia."
What constitutes overly aggressive mobilization of the esophagus? What does Dr Angelchik mean by "... reconstituted lower esophageal high-pressure zone..."? How does Dr Angelchik know that ascent of the prosthesis leads to reflux and descent leads to dysphagia? Has he studied these things in an animal model or in some objective fashion in humans?
Dr Angelchik's statement that he has never removed a prosthesis in almost 300 patients does not mean that none of his patients have had a prosthesis removed. Furthermore, he suggests that with other surgeons there is a learning curve of