More beads, more peristaltic reserve, better outcomes: factors predicting postoperative dysphagia after magnetic sphincter augmentation

Dominguez-Profeta, Rebeca; Cheverie, Joslin; Blitzer, Rachel R.; Lee, Arielle M; McClain, Lauren; Broderick, Ryan C.; Sandler, Bryan J.; Jacobsen, Garth R.; Horgan, Santiago; Kunkel, David C.

doi:10.1007/s00464-020-08013-5

Cited by 9 publications

(10 citation statements)

References 26 publications

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“…Preoperative identification of manometric abnormalities would be useful to stratify patients with an increased risk of persistent dysphagia. Dominguez-Profeta et al [89] found that adequate peristaltic reserve using the DCI after multiple rapid swallows correlated with a decreased incidence of dysphagia following MSA implantation. In a multicenter study including 210 patients, 105 with IEM and 105 without IEM, Baison et al [90] found that age > 45 years, preoperative dysphagia, MSA size < 15 beads, and < 40% intact swallows on preoperative manometry were independent risk factors for the need of endoscopic dilation or device removal.…”

Section: High-resolution Manometry and Impedance Planimetry Findingsmentioning

confidence: 99%

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

Froiio¹,

Tareq²,

Riggio³

et al. 2023

Eur Surg

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Summary Background The burden of gastroesophageal reflux disease (GERD) is high, with up to 30% of the Western population reporting reflux-related symptoms with or without hiatal hernia. Magnetic sphincter augmentation (MSA) is a standardized laparoscopic procedure for patients who are dissatisfied with medical therapy and for those with early-stage disease who would not usually be considered ideal candidates for fundoplication. The MSA device is manufactured in different sizes and is designed to augment the physiologic barrier to reflux by magnetic force. Methods An extensive scoping review was performed to provide a map of current evidence with respect to MSA, to identify gaps in knowledge, and to make recommendations for future research. All the authors contributed to the literature search in PubMed and Web of Science and contributed to summarizing the evidence. Results Magnetic sphincter augmentation, especially in combination with crural repair, is effective in reducing GERD symptoms, proton pump inhibitor use, and esophageal acid exposure, and in improving patients’ quality of life. Safety issues such as device erosion or migration have been rare and not associated with mortality. The MSA device can be removed laparoscopically if necessary, thereby preserving the option of fundoplication or other therapies in the future. Contraindication to scanning in high-power Tesla magnetic resonance systems remains a potential limitation of the MSA procedure. High-resolution manometry and functional lumen imaging probes appear to be promising tools to predict procedural outcomes by improving reflux control and reducing the incidence of dysphagia. Conclusion A consensus on acquisition and interpretation of high-resolution manometry and impedance planimetry data is needed to gain better understanding of physiology, to improve patient selection, and to pave the way for a personalized surgical approach in antireflux surgery.

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Section: High-resolution Manometry and Impedance Planimetry Findingsmentioning

confidence: 99%

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

Froiio¹,

Tareq²,

Riggio³

et al. 2023

Eur Surg

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“…Ayazi et al [ 28 ▪ ] reported that that less than 80% peristaltic contractions in the distal esophagus was a predictor of persistent dysphagia. Dominguez-Profeta et al [ 29 ▪ ] found that using multiple rapid swallows during high-resolution manometry is useful to predict patients at risk for postoperative dysphagia. The esophago-gastric junction outflow resistance imposed by MSA was investigated in a series of 43 patients free of dysphagia at 1 year after surgery.…”

Section: Dysphagia and Esophageal Motilitymentioning

confidence: 99%

“…However, a variety of sizing criteria were adopted. Recent data suggest that patients with a small (12–14 beads) vs a larger MSA implant (15–17 beads) had a significantly higher rate of postoperative dysphagia (58.5% vs 30.0% P = 0.026) [ 29 ▪ ]. Consequently, most surgeons now over-size by 3 (rather than 2) clicks of the sizing device.…”

Section: Intra-operative Managementmentioning

confidence: 99%

“…Changes in device sizing protocols and patient management pathways have been recommended to reduce the need for dilatation. Increase in size of the device, frequent bites of solid food, use of oral steroids, and avoidance of early dilatations seem to have decreased the rate of postoperative dysphagia [ 28 ▪ , 29 ▪ , 30 ▪▪ , 31 ▪ , 32 – 35 , 36 ▪ ].…”

Section: Prophylaxis and Management Of Post-operative Dysphagiamentioning

confidence: 99%

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The role of magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease

Bonavina

Boyle

Schoppmann

2021

Current Opinion in Gastroenterology

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Purpose of reviewMagnetic sphincter augmentation (MSA) has been designed as a less disruptive and more standardized laparoscopic surgical procedure than fundoplication for patients with early stage gastroesophageal reflux disease (GERD). We analyzed the more recent literature in search of updates regarding indications, technique, perioperative management, and long-term outcomes.Recent findingsOver the years, the procedure of MSA has evolved to including full hiatus repair rather than relying on the preservation of the phreno-esophageal ligament. Restoring the mechanical synergy between the lower esophageal sphincter and the crural diaphragm has the potential to further enhance the antireflux barrier. The adoption of this approach has led to expand the indications from early stage disease to different scenarios including patients with high esophageal acid exposure, atypical symptoms, large hiatal hernias, Barrett's esophagus, postbariatric surgery, and previously failed fundoplication.SummaryMSA has a favorable side-effect profile and is highly effective in reducing typical reflux symptoms, medication dependency, and esophageal acid exposure. Excellent outcomes have been confirmed over a 12-year follow-up, indicating that the operation has the potential to prevent GERD progression. Further studies are needed to confirm the cost-effectiveness of this procedure in patients with more advanced disease-stage and prior gastric surgery. A randomized control trial comparing MSA with fundoplication could raise the level of evidence and the strength of recommendation.

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“…Information obtained from HRM and provocative maneuvers may aid in tailoring the approach and further risk stratification prior to these interventions. [36][37][38][39] Impedance-pH monitoring on PPI therapy can be utilized to confirm the presence of PPI refractory GERD and guide the decision toward anti-reflux intervention, and in other cases monitoring may identify controlled GERD and move treatment away from escalated intervention. 7 In patients with obesity, Roux-en-Y gastric bypass is preferred given its effectiveness as an anti-reflux and bariatric surgery.…”

Section: Personalized Management For Objective Gerdmentioning

confidence: 99%

Personalized Approach to the Management of GERD: GI Perspective

Knotts

Yadlapati

2021

Foregut

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More beads, more peristaltic reserve, better outcomes: factors predicting postoperative dysphagia after magnetic sphincter augmentation

Cited by 9 publications

References 26 publications

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

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

The role of magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease

Personalized Approach to the Management of GERD: GI Perspective

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