Removal of the magnetic sphincter augmentation device: an assessment of etiology, clinical presentation, and management

Eriksson, Sven; Schwameis, Katrin; Ayazi, Shahin; Hoppo, Toshitaka; Zheng, Ping; Jobe, Blair A.

doi:10.1007/s00464-023-09878-y

Cited by 6 publications

(3 citation statements)

References 33 publications

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“…However, we previously published our experience with MSA removal and found that the indications for removal were persistent dysphagia (78%) followed by inadequate control (22%). 27 In our experience, no patients have required device removal for GBS. Therefore, we recommend watchful waiting with lifestyle modification and medications for the management of GBS.…”

Section: Discussionmentioning

confidence: 76%

Gas-Bloat Syndrome after Magnetic Sphincter Augmentation: Incidence, Natural History, Risk Factors, and Impact on Surgical Outcomes Over Time

Eriksson,

Ayazi,

Zheng

et al. 2023

Journal of the American College of Surgeons

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Background: The notion that gas-bloat syndrome (GBS) after magnetic sphincter augmentation (MSA) is less detrimental, has not been substantiated by data. This study aimed to identify the incidence, natural history, risk factors and impact on outcomes of GBS after MSA. Study Design: Records of patients who underwent MSA at our institution were reviewed. GBS was defined as ≥4 on the gas-bloat-specific item within the GERD-HRQL questionnaire. Preoperative clinical and objective testing data were compared between those with and without GBS at 1-year using univariate followed by multivariable analysis. GBS evolution overtime and its impact on outcome were assessed in those with 1-year and 2-year follow-up. Results: A total of 489 patients underwent MSA. At a mean (SD) follow-up of 12.8 (2.1) months, patient satisfaction was 88.8%, 91.2% discontinued antisecretory medications and 74.2% achieved DeMeester score normalization. At 1-year, 13.3% of patients developed GBS, and had worse GERD-HRQL scores, antisecretory medication use and satisfaction (p<0.0001). DeMeester score normalization was comparable (p=0.856). Independent predictors of GBS were bloating (OR:1.8, p=0.043), GERD-HRQL score >30 (OR:3.0, p=0.0010) and MSA size ≤14 beads (OR:2.5, p=0.004). In a subgroup of 239 patients with 2-year follow-up, 70.4% of patients with GBS at 1-year had resolution by 2-years. The GERD-HRQL total score improved when GBS resolved [11 (7-19) to 7 (4-10), p=0.016]. Patients with persistent GBS at 2-years had worse 2-year GERD-HRQL total scores [20 (5-31) vs 5 (3-12) p=0.019]. Conclusion: Gas-bloat syndrome affects 13.3% of patients at 1-year after MSA and substantially diminishes outcomes. However, GBS resolves spontaneously with quality of life improvement. Patients with preoperative bloating, high GERD-HRQL scores or small MSA devices are at greatest risk of this complication.

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Section: Discussionmentioning

confidence: 76%

Gas-Bloat Syndrome after Magnetic Sphincter Augmentation: Incidence, Natural History, Risk Factors, and Impact on Surgical Outcomes Over Time

Eriksson,

Ayazi,

Zheng

et al. 2023

Journal of the American College of Surgeons

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“…In a retrospective study of 425 patients with a removal rate of 5.5%, Tatum et al (15) suggested to avoid additional intervention and to redo an MSA implant or perform fundoplication only in patient with malposition of the device or hiatal hernia. In a recent study, removal for dysphagia yielded excellent outcomes regardless of concurrent antireflux repair, whereas patients with persistent GERD had worse outcomes without antireflux repair ( 26). Our preference is to perform a posterior Toupet fundoplication in patients with hiatal hernia or persistent GERD, and an anterior fundoplication in patients with erosion.…”

Section: Discussionmentioning

confidence: 99%

Safety profile of magnetic sphincter augmentation for gastroesophageal reflux disease

Froiio,

Aiolfi,

Bona

et al. 2023

Front. Surg.

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BackgroundThe magnetic sphincter augmentation (MSA) procedure is an effective treatment for gastroesophageal reflux disease (GERD). Adverse events requiring MSA device removal are rare, but the true prevalence and incidence may be underestimated.MethodsRetrospective study on a prospectively collected database. Patients who underwent MSA procedure between March 2007 and September 2021 in two tertiary-care referral centers for esophageal surgery were included. The trend of MSA explant, the changes in the sizing technique and crura repair over the years, the technique of explant, and the clinical outcomes of the revisional procedure were reviewed.ResultsOut of 397 consecutive patients, 50 (12.4%) underwent MSA removal, with a median time to explant of 39.5 [IQR = 53.7] months. Main symptoms leading to removal were dysphagia (43.2%), heartburn (25%), and epigastric pain (13.6%). Erosion occurred in 2.5% of patients. Smaller (12- and 13-bead) devices were the ones most frequently explanted. The majority of the explants were performed laparoscopically with endoscopic assistance. There was no perioperative morbidity, and the median length of stay was 2.8 ± 1.4 days. After 2014, changes in sizing technique and crura repair resulted in a decreased incidence of explants from 23% to 5% (p < 0.0001). Multivariate analysis confirmed the protective role of added bead units [HR 0.06 (95% CI = 0.001–0.220); p < 0.000].ConclusionOversizing and full mediastinal dissection with posterior hiatoplasty may improve the outcomes of the MSA procedure and possibly reduce removal rates.

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“…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…”

Section: Classifying Dysfunction After Magnetic Sphincter Augmentationmentioning

confidence: 99%

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

Dunn

Eriksson

Jobe

et al. 2023

Foregut: The Journal of the American Foregut Society

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Endoscopic evaluation after antireflux surgery is a challenge, due to the complexity of anatomy, variations in anatomical repairs, and the various patterns of failure. Studies have demonstrated that endoscopy reports of postoperative examinations are often inaccurate and inconsistent. The key to consistent high quality endoscopic examinations of the integrity of an antireflux surgery is a sound foundation in the native anatomical gastroesophageal junction and an understanding of the anatomy of the various postoperative configurations. This review will clarify the critical details necessary to perform a detailed endoscopic evaluation of the patient with suspected gastroesophageal reflux, and highlight key features to distinguish the intact repair from the dysfunctional one. It first explores the anatomical components of the native gastroesophageal junction and the unique geometric architecture that manifests in the physiologic reflux barrier. Then details the essential structures to evaluate and techniques to perform in an endoscopic examination prior to an antireflux surgery. It then systematically examines the altered anatomy and postoperative changes in endoscopic appearance after Nissen, Toupet, and Dor fundoplication, Collis gastroplasty, magnetic sphincter augmentation, and transoral incisionless fundoplication. Finally, to aid in the endoscopic diagnosis of specific dysfunction, it discusses the various patterns of failure after antireflux surgery, their characteristic endoscopic appearances, and the most useful adjunct testing modalities to augment the endoscopic examination when diagnosis is unclear.

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Removal of the magnetic sphincter augmentation device: an assessment of etiology, clinical presentation, and management

Cited by 6 publications

References 33 publications

Gas-Bloat Syndrome after Magnetic Sphincter Augmentation: Incidence, Natural History, Risk Factors, and Impact on Surgical Outcomes Over Time

Gas-Bloat Syndrome after Magnetic Sphincter Augmentation: Incidence, Natural History, Risk Factors, and Impact on Surgical Outcomes Over Time

Safety profile of magnetic sphincter augmentation for gastroesophageal reflux disease

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

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