Evaluation of Angelchik antireflux prosthesis

Kozarek, Richard A.; Brayko, Craig M.; Sanowski, Robert A.; Grobe, Justin L; Phelps, J E; Sarles, H; Fredell, C. Herbert

doi:10.1007/bf01320485

Cited by 22 publications

(2 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This potentially catastrophic complication has not occurred in our adult patients. In addition, the serious problem of persistent dysphagia reported by Wale and co-workers and others has not been a serious problem in our experience [14][15][16][17][18]. We have not had to remove a prosthesis because of persistent dysphagia and/or gas bloat.…”

Section: Discussionmentioning

confidence: 48%

Assessment of the Angelchik prosthesis for treatment of symptomatic esophageal reflux

et al. 1987

View full text Add to dashboard Cite

During a recent 5‐year period, 74 patients were fitted with an Angelchik antireflux prosthesis for symptomatic reflux esophagitis. Seventy‐five percent of 28 patients in the initial series (series 1) have had excellent to very good response to the prosthesis, as indicated by a clinical follow‐up of 36–60 mo. The main cause of failure in this series was prosthesis disruption (4 of 28 patients). Ninety‐two percent of 46 patients in the more recent series (series 2) have had excellent to very good response to prosthesis placement. The new prosthesis design, which includes a circumferential strap, has completely eliminated prosthesis disruption. Of the total series of patients, 19% of patients experienced transient dysphagia. This complication was no longer significant by 6 mo postoperatively, and no prostheses have had to be removed because of this complication. There have been no instances of erosion of the prosthesis. In addition to clinical data, lower esophageal sphincter measurements and recently, 24‐hr ambulatory pH monitoring have demonstrated a physiological effect of reflux protection after prosthesis placement. In our experience, the Angelchik prosthesis has been especially useful in high‐risk patients, patients who have recurrent esophagitis after previous antireflux or foregut surgery, and patients who would probably not have been referred for conventional antireflux surgery. In view of our data, we believe that the Angelchik prosthesis should continue to be commercially available as a surgical option for treating selected patients with medically refractory reflux esophagitis.

show abstract

Section: Discussionmentioning

confidence: 48%

Assessment of the Angelchik prosthesis for treatment of symptomatic esophageal reflux

et al. 1987

View full text Add to dashboard Cite

show abstract

“…As a result of this nonconforming nature, the erosion and migration rate for the Angelchik occurred earlier after implant and at a higher rate than the magnetic sphincter device. 35,36 Therefore, past experiences with the Angelchik should have no significant bearing on the magnetic sphincter procedure.…”

Section: Commentsmentioning

confidence: 99%

A Modern Magnetic Implant for Gastroesophageal Reflux Disease

Ganz

2017

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

A magnetic implant for the treatment of gastroesophageal reflux disease (GERD) was Food and Drug Administration-approved in 2012 and has been extensively evaluated. The device is a ring of magnets that are placed around the gastroesophageal junction, augmenting the native lower esophageal sphincter and preventing reflux yet preserving lower esophageal sphincter physiologic function and allowing belching and vomiting. Magnetic force is advantageous, being permanent and precise, and forces between magnets decrease with esophageal displacement. Multiple patient cohorts have been studied using the magnetic device, and trials establish consistent, long-term improvement in pH data, GERD symptom scores, and proton-pump inhibitor use. A 5-year Food and Drug Administration trial demonstrated that most patients achieved normal pH scores, 85% stopped proton-pump inhibitors, and GERD health-related quality of life symptom scores improved from 27 to 4 at 5 years. Seven studies have compared magnetic augmentation with laparoscopic Nissen fundoplication and demonstrated that the magnetic device achieved comparable efficacy with regard to proton-pump inhibitor cessation, GERD symptom score improvement, and heartburn and regurgitation scores. However, to date there have been no randomized, controlled trials comparing the 2 techniques, and the study cohorts are not necessarily comparable regarding hiatal hernia size, severity of reflux, body mass index scores, or esophagitis scores. Dysphagia incidence was similar in both groups. Reoperation rates and safety profiles were also comparable, but the magnetic device demonstrated significant beneficial differences in allowing belching and vomiting. The magnetic device is safe, with the main adverse event being dysphagia with an approximate 3%-5% chronic incidence. Device removals in clinical trials have been between 0% and 7% and were uneventful. There have been no erosions, perforations, or infections in FDA clinical trials; erosions have rarely been noted in practice. Magnetic augmentation of the lower esophageal sphincter is a safe and effective operation for GERD, and should be considered a surgical option for those seeking a fundic-sparing operation, particularly those with parameters consistent with study cohorts. Additional randomized, controlled trials are underway.

show abstract

The Effect of the Angelchik Prosthesis on Esophageal and Gastric Function

Maddern

Myers²,

McIntosh³

et al. 1991

Arch Surg

View full text Add to dashboard Cite

The effects of the Angelchik prosthesis on esophageal and gastric function were investigated in 17 patients (11 men and six women; median age, 57 years; age range, 36 to 88 years) who underwent surgery for treatment of gastroesophageal reflux disease. All patients demonstrated unequivocal reflux, either at endoscopy or 24-hour pH testing. There was a significant increase in lower esophageal sphincter pressure after surgery, and no patient demonstrated abnormal reflux on pH testing. Gastric emptying of liquids and solids was not altered by surgery. Six months after surgery, all symptoms except dysphagia had significantly improved. Thirty-three months after surgery, six patients described symptoms as severe as or worse than those before surgery. Four patients had the prosthesis removed, two because of dysphagia alone, one because of reflux and dysphagia, and one because of flatulence and bloating. The patients who required removal of the prosthesis because of dysphagia had gross delay of esophageal emptying. We conclude that the Angelchik prosthesis is an effective antireflux device, but it interferes with esophageal function in some patients, requiring removal of the prosthesis. We think the rate of removal of the prosthesis is too high for its routine use in the treatment of gastroesophageal reflux disease.

show abstract

Evaluation of Angelchik antireflux prosthesis

Cited by 22 publications

References 26 publications

Assessment of the Angelchik prosthesis for treatment of symptomatic esophageal reflux

Assessment of the Angelchik prosthesis for treatment of symptomatic esophageal reflux

A Modern Magnetic Implant for Gastroesophageal Reflux Disease

The Effect of the Angelchik Prosthesis on Esophageal and Gastric Function

Contact Info

Product

Resources

About