Spotlight on the Linx™ Reflux Management System for the treatment of gastroesophageal reflux disease: evidence and research

Abstract

BackgroundThe initial approach to gastroesophageal reflux disease (GERD) management typically involves lifestyle modification and medical therapy utilizing acid reducing agents such as histamine blockers and proton pump inhibitors. In severe cases refractory to such treatments, surgical therapy may be indicated. The gold standard for surgical treatment of GERD is the laparoscopic Nissen fundoplication. In recent years, a new technique known as magnetic sphincter augmentation (MSA) has been developed using the Linx™ Reflux Management System. This is an implantable ring of magnetic beads that is placed around the esophagus at the gastroesophageal junction to restore lower esophageal integrity. The aim of this review is to discuss the current literature regarding indications, surgical technique, efficacy, and complications of MSA using the Linx device.MethodsA standardized literature search was performed yielding 367 abstracts. After elimination due to duplicates between databases and irrelevance, 96 articles remained. The information found to be significant and non-redundant was included in this review.ConclusionAfter several years of clinical application, the Linx device has been shown to not only be effective for the management of GERD but also be as effective as fundoplication. With respect to safety, the most common complication of MSA is dysphagia. This often resolved without intervention, but esophageal dilation or device explanation are occasionally necessary. Not fully appreciated in earlier reviews, erosion of the device into the esophagus appears to be the most significant complication of the device after extended follow-up. While very rare, the potentially severe consequences of this phenomenon suggest that the device should be used with some restraint and that patients should be made aware of this potential morbidity. Fortunately, in the few cases of device erosion described in the literature reviewed, the Linx device was easily and safely removed.

Clinical Outcomes and Predictors of Favorable Result after Laparoscopic Magnetic Sphincter Augmentation: Single-Institution Experience with More than 500 Patients

“…Early postoperative dysphagia has been reported in 43% to 83% of patients and resolves in most of these patients. 32,33 But this symptom can persist in some and might require endoscopic dilation or device removal. In this study, 15% of the patients had persistent dysphagia and 30.1% required at least 1 dilation.…”

Magnetic Sphincter Augmentation and Postoperative Dysphagia: Characterization, Clinical Risk Factors, and Management

“…Although studies suggest that the side effect profile of MSA is superior to LNF as evidenced by less gas bloating and a preserved ability to belch and vomit, 9 postoperative dysphagia remains the most common complaint of patients after MSA. Early postoperative dysphagia has been reported in 43-83% of the patients.…”

(Patho-)Physiology of Na+/H+ Exchangers (NHEs) in the Digestive System

“…Gastroesophageal reflux disease is characterized by the destruction of the esophageal mucosa caused by uncontrolled reflux of gastric acid, which eventually leads to the formation of esophageal ulcers (Zadeh et al, 2018). Due to the fact that NHE1 expression at mRNA level was detected in both rat and rabbit esophagus, it was assumed that NHE1 may be associated with cytoplasmic pH regulation in esophageal cells and thus contributes to the esophageal defense against the gastric acid reflux (Shallat et al, 1995).…”