Regression of Barrett’s esophagus after magnetic sphincter augmentation: intermediate-term results

Dunn, Colin P; Henning, Justin C; Sterris, Jason A; Won, Paul; Houghton, Caitlin C.; Bildzukewicz, Nikolai A.; Lipham, John C.

doi:10.1007/s00464-020-08074-6

Cited by 12 publications

(7 citation statements)

References 30 publications

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“…A multivariable logistic regression analysis confirmed that full mediastinal dissection with restoration of intraabdominal esophageal length and formal crural repair was most likely to normalize esophageal acid exposure (point estimate 1.73; 95% confidence interval 1.15-8.19; p = 0.02) [71]. Last but not least, regression of Barrett's esophagus was observed in 72% of patients at 1 year after Linx implant; interestingly, patients with short-segment intestinal metaplasia in whom esophageal acid exposure reversed to normal were more likely to achieve regression [72,73].…”

Section: Early and Intermediate-term Outcomesmentioning

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: Early and Intermediate-term Outcomesmentioning

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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“…It should be noted, however, that the mean follow-up time of the entire cohort was 2.3 years. Another study [ 22 ▪ ] reported on 79 patients undergoing MSA for large (>3 cm) hiatal hernia. Over a median follow-up of 2.9 years, median GERD-HRQL scores, DeMeester scores, and severity of esophagitis decreased significantly, and the hiatal hernia recurrence rate was 6.3%.…”

Section: Effect Of Magnetic Sphincter Augmentation Across the Spectru...mentioning

confidence: 99%

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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“…Auch bez. der Barrett-Remissionsraten (70 % nach 12 Monaten, abhängig vom Barrett-Entwicklungsgrad) scheint die MSA mit den Ergebnissen nach Fundoplikation vergleichbar [20]. Einen Vorteil für die MSA im Vergleich zur laparoskopischen Fundoplikation beschreiben die meisten Studien bez.…”

Section: Magnetische Sphinkteraugmentation (Msa)unclassified

Alternative operative Verfahren zur Behandlung der gastroösophagealen Refluxerkrankung

Schoppmann

2021

Zentralbl Chir

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ZusammenfassungDas Versagen der medikamentösen Therapie bei mehr als 30% der Patienten mit gastroösophagealer Refluxerkrankung (GERD) wie auch zunehmende Bedenken bez. einer säurehemmenden Dauertherapie haben zu einer neuen Fokussierung auf chirurgische Antirefluxtherapien geführt. Unter den Sphinkteraugmentationsverfahren haben die beiden laparoskopischen Verfahren, die magnetische (LINX) und die elektrische (EndoStim), eine breitere Anwendung gefunden. Die magnetische Sphinkteraugmentation stellte eine sehr sichere (Komplikationsrate 0,1% und Reoperationsrate 3,4%) Methode dar, die sowohl zu signifikanten Verbesserungen der subjektiven (GERD-HRQL-Verbesserung 19,9 auf 4,1; p = 0,001) als auch objektiven GERD-Erfolgsparameter (79% PPI-Freiheit und 89% Normalisierung der Säureexposition im distalen Ösophagus) führt. Die elektrische Sphinkteraugmentation hat erste vielversprechende Kurzzeitergebnisse in geringen Patientenanzahlen gezeigt (92% subjektive Beschwerdeverbesserung). Ein Vergleich zum operativen Goldstandard der laparoskopischen Fundoplikation ist bei beiden Methoden ausständig. Alternative, laparoskopische Antirefluxmethoden stellen eine potenzielle Alternative zur laparoskopischen Fundoplikation dar.

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Regression of Barrett’s esophagus after magnetic sphincter augmentation: intermediate-term results

Cited by 12 publications

References 30 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

Alternative operative Verfahren zur Behandlung der gastroösophagealen Refluxerkrankung

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