Lutheran names first among Intermountain’s Front Range hospitals

Emily Speer, MD, General & Bariatric Surgery, has been named Lutheran's Foregut Surgery medical director, the first position of its kind among our Front Range hospitals. We sat down virtually with Speer to talk about the importance of this milestone, the growth of this specialty and the care Lutheran provides.

Q: How does it feel to be the first Foregut Surgery medical director for our region?

A: I'm honored to be the first to step into this specific role for our Front Range hospitals. Creating this role is very timely, as now more than ever the field of reflux/esophageal surgery is rapidly growing. This new role reflects a growing national recognition that foregut surgery, which encompasses conditions like GERD, hiatal hernias, achalasia and other esophageal disorders, is a distinct subspecialty requiring focused leadership, standardized care pathways and quality oversight. National societies including SAGES and AFS have been actively working to strengthen and formalize foregut surgery as a recognized subspecialty, and creating dedicated leadership positions like this one is part of that evolution.

Q: What is Lutheran’s goal in developing this program?

A: What we are building at Lutheran is something very meaningful and purposeful: a true hub of excellence for complex foregut care across the Intermountain Health Peaks Region system. The evidence strongly supports this approach. A study of more than 75,000 antireflux surgeries in the US demonstrated that high-volume hospitals have significantly lower rates of complications - including bleeding, esophageal perforation, respiratory failure and mortality - along with shorter hospital stays and lower costs compared to low- and intermediate-volume centers. Similarly, data on paraesophageal hernia repair show that high-volume centers have nearly four-times lower mortality rates compared to low-volume centers. By concentrating complex foregut work at Lutheran and establishing standardized protocols across the region, we can deliver these volume-driver outcomes to every patient in our system.

Q: What do you feel Lutheran needs to do to achieve its goals for this program?

A: Building a premier foregut program requires several key elements: fellowship-trained foregut surgeons who maintain robust annual case volumes, a comprehensive diagnostic infrastructure that includes high-resolution manometry, ambulatory pH monitoring, advanced endoscopy and a multidisciplinary team with gastroenterologists, esophageal-trained radiologists, and specialized nursing and support staff. Equally important is a commitment to standardized preoperative evaluation: Every surgical candidate should have objective confirmation of their diagnosis through testing like endoscopy, reflux testing and motility assessment before any operations. This is the standard of care endorsed by the ACG, AGA, SAGES, AFS, and SSAT. Finally, we need robust outcomes-tracking and quality-improvement processes so we can continuously measure and improve our results.

Q: What would you say are some of the most-recent, meaningful advancements in foregut surgery care? What's on the horizon?

A: Foregut surgery has seen remarkable innovation in recent years. Magnetic sphincter augmentation (the LINX device) has emerged as a strong alternative to traditional fundoplication, offering excellent reflux control with shorter operative times, faster recovery and fewer side effects like gas bloat and dysphagia. Anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA) are other emerging, purely endoscopic techniques showing promising early results, and we will offer that soon here at Lutheran. 

On the horizon, we are seeing a shift toward truly personalized surgical approaches - tailoring the specific procedure to each patient's unique anatomy, motility profile, and disease phenotype - rather than applying a one-size-fits-all approach. Novel devices like RefluxStop are being studied in Europe and may offer additional options. The field also is moving toward better integration of endoscopic and surgical therapies, with foregut surgeons increasingly trained to be proficient in both domains. Here at Lutheran, we offer a variety of endoscopic surgical options, including per oral endoscopic myotomy for Zenker's diverticulum, achalasia, and gastroparesis, and the scope of endoscopic surgery is rapidly expanding. We plan to stay at the forefront of these newer therapies.

Q: What more would you like physicians to know about foregut surgery and care at Lutheran?

A: Three things. First, foregut surgery, especially reoperative surgery for failed prior repairs, demands specialized training, expertise and sufficient case volume. The data are clear: Surgeon experience is one of the strongest predictors of a successful antireflux surgery outcome, and reoperative foregut surgery carries higher complication rates that are best managed by surgeons who do this work regularly. National benchmarks reiterate that foregut surgeons should be performing a robust volume of cases annually to maintain proficiency. 

Second, Lutheran will serve as a hub for complex foregut surgery in the Peaks Region. This means that when a patient first presents at any Intermountain Health hospital along the Front Range, they will have access to the same high standard of evaluation and, when their local physicians deem it necessary, referral to Lutheran for complex or reoperative procedures. Our goal is the ensure that every patient receives state-of-the-art care regardless of where they reside in our system.

Third, we are dedicated to collaboration. This role is about elevating care across the entire region, not limiting anyone's practice. Straightforward primary foregut cases can and should be performed by well-trained surgeons throughout the system. What we want to ensure is that complex cases - reoperative surgery, giant paraesophageal hernias, patients with failed prior repairs, and cases requiring advanced diagnostic workup - are directed to the team and infrastructure best equipped to handle them. This is how we as a system get the best outcomes for our patients.

Thank you, Dr. Speer, for sharing your vision with us! Physicians with questions about foregut surgery at Lutheran can email Speer at emily.speer@imail.org.