Esophageal Penetration of the Magnetic Sphincter Augmentation Device: History Repeats Itself

Salvador, Renato; Costantini, Mario; Capovilla, Giovanni; Polese, Lino; Merigliano, Stefano

doi:10.1089/lap.2017.0182

Cited by 13 publications

(6 citation statements)

References 18 publications

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“…Salvador et al reported two cases of severe dysphagia after MSA procedure due to migration of the device into the esophagus. The devices were safely removed endoscopically in a single step in both cases 47 . In agreement, Bona et al concluded in 2021 that MSA devices can be safely explanted via a single-stage laparoscopic procedure associated with common antireflux procedures 9 .…”

Section: Discussionmentioning

confidence: 99%

Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux Disease: Effective, but Postoperative Dysphagia and Risk of Erosion Should Not Be Underestimated. A Systematic Review and Meta-Analysis

Valinoti,

Angeramo,

Dreifuss

et al. 2023

ABCD, arq. bras. cir. dig.

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BACKGROUND: Magnetic ring (MSA) implantation in the esophagus is an alternative surgical procedure to fundoplication for the treatment of gastroesophageal reflux disease. AIMS: The aim of this study was to analyse the effectiveness and safety of magnetic sphincter augmentation (MSA) in patients with gastroesophageal reflux disease (GERD). METHODS: A systematic literature review of articles on MSA was performed using the Medical Literature Analysis and Retrieval System Online (Medline) database between 2008 and 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) across all studies. RESULTS: A total of 22 studies comprising 4,663 patients with MSA were analysed. Mean follow-up was 27.3 (7–108) months. The weighted pooled proportion of symptom improvement and patient satisfaction were 93% (95%CI 83–98%) and 85% (95%CI 78–90%), respectively. The mean DeMeester score (pre-MSA: 34.6 vs. post-MSA: 8.9, p=0.03) and GERD-HRQL score (pre-MSA: 25.8 vs. post-MSA: 4.4, p<0.0001) improved significantly after MSA. The proportion of patients taking proton pump inhibitor (PPIs) decreased from 92.8 to 12.4% (p<0.0001). The weighted pooled proportions of dysphagia, endoscopic dilatation and gas-related symptoms were 18, 13, and 3%, respectively. Esophageal erosion occurred in 1% of patients, but its risk significantly increased for every year of MSA use (odds ratio — OR 1.40, 95%CI 1.11–1.77, p=0.004). Device removal was needed in 4% of patients. CONCLUSIONS: Although MSA is a very effective treatment modality for GERD, postoperative dysphagia is common and the risk of esophageal erosion increases over time. Further studies are needed to determine the long-term safety of MSA placement in patients with GERD.

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Section: Discussionmentioning

confidence: 99%

Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux Disease: Effective, but Postoperative Dysphagia and Risk of Erosion Should Not Be Underestimated. A Systematic Review and Meta-Analysis

Valinoti,

Angeramo,

Dreifuss

et al. 2023

ABCD, arq. bras. cir. dig.

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“…In case of device erosion, different solutions for MSA removal have been described ranging from single-stage endoscopic retrieval to hybrid endo-laparoscopic two-stage strategies [26][27][28][29]. In case of dysphagia or recurrent GERD symptoms, a single-stage laparoscopic approach under endoscopic assistance has been reported [10,30].…”

Section: Discussionmentioning

confidence: 99%

Magnetic sphincter augmentation device removal: surgical technique and results at medium-term follow-up

Bona

Saino

Mini

et al. 2021

Langenbecks Arch Surg

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Background The magnetic sphincter augmentation (MSA) device has become a common option for the treatment of gastroesophageal reflux disease (GERD). Knowledge of MSA-related complications, indications for removal, and techniques are puzzled. With this study, we aimed to evaluate indications, techniques for removal, surgical approach, and outcomes with MSA removal. Methods This is an observational singe-center study. Patients were followed up regularly with endoscopy, pH monitoring, and assessed for specific gastroesophageal reflux disease health-related quality of life (GERD-HRQL) and generic short-form 36 (SF-36) quality of life. Results Five patients underwent MSA explant. Four patients were males and the median age was 47 years (range 44–55). Heartburn, epigastric/chest pain, and dysphagia were commonly reported. The median implant duration was 46 months (range 31–72). A laparoscopic approach was adopted in all patients. Intraoperative findings included normal anatomy (40%), herniation in the mediastinum (40%), and erosion (20%). The most common anti-reflux procedures were Dor (n = 2), Toupet (n = 2), and anterior partial fundoplication (n = 1). The median operative time was 145 min (range 60–185), and the median hospital length of stay was 4 days (range 3–6). The median postoperative follow-up was 41 months (range 12–51). At the last follow-up, 80% of patients were off PPI; the GERD-HRQL and SF-36 questionnaire were improved with DeMeester score and esophageal acid exposure normalization. Conclusion The MSA device can be safely explanted through a single-stage laparoscopic procedure. Tailoring a fundoplication, according to preoperative patient symptoms and intraoperative findings, seems feasible and safe with a promising trend toward improved symptoms and quality of life.

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“…Symptoms prompting removal of the MSA device were eliminated in 52% of patients and improved in an additional 35%, whereas in 13% of cases the symptoms persisted. As removal of the MSA device is followed not only by recurrent GER, but also by a delayed gastric emptying, prokinetics should be added to the medical therapy with a PPI[ 49 ] or surgical treatment with fundoplication[ 52 ]. The onset of delayed gastric emptying after removal may be easily explained by damage to the right branch of the vagus nerve, which runs along the posterior part of the abdominal esophagus.…”

Section: The Msa Devicementioning

confidence: 99%

Magnetic challenge against gastroesophageal reflux

Bortolotti¹

2021

WJG

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Almost 15 years have passed since the first paper on the possibility of using magnets to prevent gastro-esophageal reflux (GER) was published and so it is time to assess the results obtained with the first magnetic device available on the market, the Linx magnetic sphincter augmentation (MSA) and to consider what other options are forthcoming. MSA demonstrated an anti-reflux activity similar to that of Nissen fundoplication, considered the “gold standard” surgical treatment for GER disease, and caused less gas-bloating and a better ability to allow vomiting and belching. However, unlike Nissen fundoplication, this magnetic device is burdened by complications, which are roughly similar to those of the non-magnetic anti-reflux Angelchik prosthesis, that, after considerable use in the eighties, was shelved due to these complications. It is interesting to note that some of these complications show the same pathophysiological mechanism in both devices. The upcoming new magnetic devices should avoid these complications, as their anti-reflux magnetic mechanism is completely different. The experiments in animals regarding these new magnetic appliances were examined, remarking their advantages and drawbacks, but the way to apply them in surgical practice is long and difficult, although worthy, as they represent the future of magnetic surgery.

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Esophageal Penetration of the Magnetic Sphincter Augmentation Device: History Repeats Itself

Cited by 13 publications

References 18 publications

Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux Disease: Effective, but Postoperative Dysphagia and Risk of Erosion Should Not Be Underestimated. A Systematic Review and Meta-Analysis

Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux Disease: Effective, but Postoperative Dysphagia and Risk of Erosion Should Not Be Underestimated. A Systematic Review and Meta-Analysis

Magnetic sphincter augmentation device removal: surgical technique and results at medium-term follow-up

Magnetic challenge against gastroesophageal reflux

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