Magnetic Sphincter Augmentation Outcomes in Severe Gastroesophageal Reflux Disease

Abstract

Introduction: Outcomes of laparoscopic procedures for gastroesophageal reflux disease (GERD) are variable depending on surgical expertise and/or patient-related factors. Some procedures may be inadequate in patients with severe disease. Effectiveness of laparoscopic magnetic sphincter augmentation (MSA) has not been extensively tested in patients with severe disease.Methods: A prospectively collected database was analyzed to identify patients who underwent MSA at a single institution. Individuals who had previous esophago-gastric surgery were excluded. Severe GERD was defined as lower esophageal sphincter pressure <5 mmHg, distal esophageal amplitude <30 mmHg, Barrett's metaplasia, stricture or grade C-D esophagitis, and/or DeMeester score >50. Clinical characteristics and outcomes of patients with severe GERD were compared with those of patients with mild to moderate GERD who served as control group.Results: Over the study period, a total of 336 patients met the inclusion criteria, and 102 (30.4%) had severe GERD. The median follow-up was 24 months (IQR = 75) in severe GERD patients and 32 months (IQR = 84) in those with non-severe GERD. Patients with severe GERD had a higher rate of dysphagia and higher GERD-HRQL scores. After the MSA procedure, symptoms, health-related quality of life scores, and proton-pump inhibitors consumption significantly decreased in both groups (p < 0.05). No difference between groups was found in the prevalence of severe post-operative dysphagia, the need for endoscopic dilation or device removal, and the DeMeester score.Conclusion: Laparoscopic MSA is safe and effective in reducing symptoms, PPI use, and esophageal acid exposure also in patients with severe GERD.

Real-world evidence with magnetic sphincter augmentation for gastroesophageal reflux disease: a scoping review

“…However, in the Nissen fundoplication group there was a higher rate of patients with inability to belch and vomit, along with more severe gas-bloat symptoms, whereas quality of life scores were similar in patients treated either by Linx or Toupet fundoplication [52][53][54][55][56][57][58][59]. Magnetic sphincter augmentation also proved effective in patients with severe GERD [60][61][62]. Two meta-analyses comparing Linx and fundoplication reported that the former was associated with less gas-bloat symptoms and an increased ability to vomit and belch, while PPI suspension rate, dysphagia requiring endoscopic dilatation, and GERD-HRQL were similar in the two patient groups [63,64].…”

Endoscopy and Antireflux Surgery: A Technical Review of Pre- and Postoperative Evaluation and Recognizing Patterns of Failure

“…The most common indications for device removal are dysphagia and persistence of GERD symptoms, which are present at 2% and 4% of implants, respectively. 15 In absence of evidence of an endoscopic or radiologic anatomical failure, a study from our center suggests that management and decision regarding revisional antireflux surgery should be tailored to the presenting symptom. 16…”

Heartburn’s Hidden Impact: A Narrative Review Exploring Gastroesophageal Reflux Disease (GERD) as a Cardiovascular Disease Risk Factor

“…Long-term outcomes of MSA have also been favorable [70,71]. A prospective study by Ferrari et al in 2020 followed 335 patients who underwent MSA implantation for 6 to 12 years following their procedures [70].…”