Update in Procedural Therapy for GERD – Magnetic Sphincter Augmentation, Endoscopic Transoral Incisionless Fundoplication vs Laparoscopic Nissen Fundoplication

Min, Michael; Ganz, Robert A.

doi:10.1007/s11894-014-0374-4

Cited by 10 publications

(4 citation statements)

References 19 publications

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“…Laparoscopic fundoplication showed similar long-term efficacy compared to PPI [ 19 ]. Magnetic sphincter augmentation, electrical stimulation of lower esophageal sphicter (LES), and endoscopic fundoplication are emerging treatment for GERD [ 9 , 20 , 21 ]. However, long-term follow-up studies are rare to date on these treatment options above.…”

Section: Discussionmentioning

confidence: 99%

Prospective, Randomized Ex Vivo Trial to Assess the Ideal Stapling Site for Endoscopic Fundoplication with Medigus Ultrasonic Surgical Endostapler

Gweon

Matthes

2016

Gastroenterology Research and Practice

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Background and Aims. Endoscopic fundoplication is an emerging technique for the treatment of gastroesophageal reflux disease (GERD). The aim of this study is to determine the ideal position of the staples in relation to gastroesophageal junction (GEJ). Methods. Ten endoscopic fundoplication procedures were performed in each group using fresh ex vivo porcine stomachs: Group A: 2 staples each at 3 cm above the GEJ and 180° apart; Group B: 2 staples at 3 cm and 90° apart; Group C: 2 staples at 4 cm and 180° apart; Group D: 3 staples at 3 cm with 90° between each staple (180° total). After the procedure, the stomach was gradually filled with water. Gastric yield pressure (GYP) was determined by detection of reflux of the water in esophagus or by rupture of staples. Results. Mean increase of GYPs (±SD) after the procedure was as follows: Group A: 16.9 ± 8.7; Group B: 8.1 ± 7.9; Group C: 12.2 ± 9.4; Group D: 22.7 ± 13.3. GYP in Group A and Group D was higher than Group B (p = 0.03 and p = 0.01, resp.). Conclusions. We recommend the placement of 3 staples at 3 cm distance from the GEJ, which resulted in the highest increase of GYP.

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Section: Discussionmentioning

confidence: 99%

Prospective, Randomized Ex Vivo Trial to Assess the Ideal Stapling Site for Endoscopic Fundoplication with Medigus Ultrasonic Surgical Endostapler

Gweon

Matthes

2016

Gastroenterology Research and Practice

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“…63 Thus, initial data supports a more favorable safety profile of the magnetic sphincter augmentation, however follow-up over a longer period is needed to understand the actual long-term outcomes [Table 2]. 61, 64…”

Section: Magnetic Sphincter Augmentationmentioning

confidence: 99%

Complications of Antireflux Surgery

Yadlapati

Hungness

Pandolfino

2018

American Journal of Gastroenterology

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Antireflux surgery anatomically restores the antireflux barrier and is a therapeutic option for proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease or PPI intolerance. Laparoscopic fundoplication is the standard antireflux surgery, though its popularity has declined due to concerns regarding wrap durability and adverse events. As the esophagogastric junction is an anatomically complex and dynamic area subject to mechanical stress, wraps are susceptible to disruption, herniation or slippage. Additionally, recreating an antireflux barrier to balance bidirectional bolus flow is challenging, and wraps may be too tight or too loose. Given these complexities it is not surprising that post-fundoplication symptoms and complications are common. Perioperative mortality rates range from 0.1 to 0.2% and prolonged structural complications occur in up to 30% of cases. Upper gastrointestinal endoscopy with a comprehensive retroflexed examination of the fundoplication and barium esophagram are the primary tests to assess for structural complications. Management hinges on differentiating complications that can be managed with medical and lifestyle optimization versus those that require surgical revision. Reoperation is best reserved for severe structural abnormalities and troublesome symptoms despite medical and endoscopic therapy given its increased morbidity and mortality. Though further data are needed, magnetic sphincter augmentation may be a safer alternative to fundoplication.

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“…The Linx procedure has since been suggested for patients who prefer surgery over long-term use of anti-reflux medications,27 those with extra-esophageal manifestations, such as chronic cough or asthma, and those with GERD following gastric surgery 25…”

Section: Indication For Usementioning

confidence: 99%

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

Zadeh¹,

Andreoni²,

Treitl³

et al. 2018

MDER

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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.

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Update in Procedural Therapy for GERD – Magnetic Sphincter Augmentation, Endoscopic Transoral Incisionless Fundoplication vs Laparoscopic Nissen Fundoplication

Cited by 10 publications

References 19 publications

Prospective, Randomized Ex Vivo Trial to Assess the Ideal Stapling Site for Endoscopic Fundoplication with Medigus Ultrasonic Surgical Endostapler

Prospective, Randomized Ex Vivo Trial to Assess the Ideal Stapling Site for Endoscopic Fundoplication with Medigus Ultrasonic Surgical Endostapler

Complications of Antireflux Surgery

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

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Update in Procedural Therapy for GERD – Magnetic Sphincter Augmentation, Endoscopic Transoral Incisionless Fundoplication vs Laparoscopic Nissen Fundoplication

Cited by 10 publications

References 19 publications

Prospective, Randomized Ex Vivo Trial to Assess the Ideal Stapling Site for Endoscopic Fundoplication with Medigus Ultrasonic Surgical Endostapler

Prospective, Randomized Ex Vivo Trial to Assess the Ideal Stapling Site for Endoscopic Fundoplication with Medigus Ultrasonic Surgical Endostapler

Complications of Antireflux Surgery

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

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