Efficacy of Magnetic Sphincter Augmentation Across the Spectrum of GERD Disease Severity

Schwameis, Katrin; Ayazi, Shahin; Zheng, Ping; Grubic, Andrew D.; Salvitti, Madison; Hoppo, Toshitaka; Jobe, Blair A.

doi:10.1016/j.jamcollsurg.2020.11.012

Cited by 13 publications

(17 citation statements)

References 38 publications

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“…They also found that Barrett’s esophagus was more common in the severe GERD group postoperatively (15.0% vs 2.9%) but also more prevalent preoperatively (27.5% vs 5.9%). 18 In our study comparing MSA to fundoplication in severe GERD, pH normalization and Barrett’s regression could not be reliably determined.…”

Section: Discussionmentioning

confidence: 66%

“…Previously, Schwameis et al 18 evaluated 334 patients who underwent MSA. Outcomes were compared between patients with severe GERD (DMS ≥ 50) and patients with mild-to-moderate GERD (DMS 14.7-50).…”

Section: Discussionmentioning

confidence: 99%

“…All patients were ≥18 years old with severe GERD, defined by preoperative DeMeester score (DMS) ≥ 50 for at least one 24-hour period during a pH monitoring study. 18,19 Patients were excluded if they were found to have evidence of esophageal dysmotility by video esophagram (VEG) or high-resolution manometry during preoperative screening. Patients were also excluded if they had prior anti-reflux surgery or a known allergy to titanium.…”

Section: Methodsmentioning

confidence: 99%

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Comparing the Outcomes of MSA and Fundoplication in Severe GERD

Wang

Silva

James

et al. 2022

Foregut: The Journal of the American Foregut Society

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Introduction: Magnetic sphincter augmentation (MSA) is an effective treatment option for gastroesophageal reflux disease (GERD), with similar outcomes to fundoplication. MSA has yet to be compared to fundoplication specifically in patients with severe GERD. The objective of this study was to compare MSA and fundoplication in patients with severe GERD. Methods: A retrospective cohort study was performed of patients with severe GERD (preoperative DeMeester score >50) who underwent MSA or fundoplication at 3 high-volume centers from 2016 to 2019. Nissen and partial fundoplications were included. GERD control was measured by GERD health-related quality of life (GERD-HRQL) scores and discontinuation of acid suppressive medication (ASM). Other outcomes included postoperative gas-bloat symptoms, dysphagia requiring dilation, and esophagitis. Results: A total of 122 patients were included: 82 (67%) underwent MSA and 40 (33%) underwent fundoplication (23% Nissen, 77% partial). The groups were similar regarding gender, GERD duration, hiatal hernia size, preoperative GERD-HRQL score, severe esophagitis, and DeMeester score. Median follow-up was 24 [12-34] months. Postoperative GERD-HRQL scores (5 vs 3, P = .36), ASM discontinuation (80% vs 86%, P = .41), gas-bloat symptoms (18% vs 23%, P = .58), dysphagia requiring dilation (19% vs 8%, P = .11), and esophagitis (7% vs 10%, P = .08) were similar between the groups. A subset analysis was performed comparing outcomes of MSA, Nissen fundoplication, and partial fundoplication. No significant differences were found. Conclusion: In this cohort of patients with severe GERD, MSA was just as effective as Nissen and partial fundoplication with regards to improved quality of life and side effect profile at 24-month follow-up.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Comparing the Outcomes of MSA and Fundoplication in Severe GERD

Wang

Silva

James

et al. 2022

Foregut: The Journal of the American Foregut Society

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“…After its introduction into clinical practice, the MSA device has progressively gained popularity and emerged as a valuable therapeutic alternative to fundoplication in patients with GERD [ 19 , 20 ]. Several single-arm trials have established consistent and long-term improvement of GERD symptoms scores, esophageal acid exposure, quality of life, and decreased use of PPI [ 2 – 6 , 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Magnetic sphincter augmentation device removal: surgical technique and results at medium-term follow-up

Bona

Saino

Mini

et al. 2021

Langenbecks Arch Surg

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Background The magnetic sphincter augmentation (MSA) device has become a common option for the treatment of gastroesophageal reflux disease (GERD). Knowledge of MSA-related complications, indications for removal, and techniques are puzzled. With this study, we aimed to evaluate indications, techniques for removal, surgical approach, and outcomes with MSA removal. Methods This is an observational singe-center study. Patients were followed up regularly with endoscopy, pH monitoring, and assessed for specific gastroesophageal reflux disease health-related quality of life (GERD-HRQL) and generic short-form 36 (SF-36) quality of life. Results Five patients underwent MSA explant. Four patients were males and the median age was 47 years (range 44–55). Heartburn, epigastric/chest pain, and dysphagia were commonly reported. The median implant duration was 46 months (range 31–72). A laparoscopic approach was adopted in all patients. Intraoperative findings included normal anatomy (40%), herniation in the mediastinum (40%), and erosion (20%). The most common anti-reflux procedures were Dor (n = 2), Toupet (n = 2), and anterior partial fundoplication (n = 1). The median operative time was 145 min (range 60–185), and the median hospital length of stay was 4 days (range 3–6). The median postoperative follow-up was 41 months (range 12–51). At the last follow-up, 80% of patients were off PPI; the GERD-HRQL and SF-36 questionnaire were improved with DeMeester score and esophageal acid exposure normalization. Conclusion The MSA device can be safely explanted through a single-stage laparoscopic procedure. Tailoring a fundoplication, according to preoperative patient symptoms and intraoperative findings, seems feasible and safe with a promising trend toward improved symptoms and quality of life.

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“…Interestingly a pre-operative DeMeester score >50 was 86% sensitive for predicting surgical failure ( 12 ). More recently, Schwameis et al ( 23 ) have stratified 334 patients undergoing MSA using the previous criteria. They found that MSA is an effective therapeutic option for patients with severe GERD as defined by a pre-operative DeMeester score ≥50.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Sphincter Augmentation Outcomes in Severe Gastroesophageal Reflux Disease

et al. 2021

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Introduction: Outcomes of laparoscopic procedures for gastroesophageal reflux disease (GERD) are variable depending on surgical expertise and/or patient-related factors. Some procedures may be inadequate in patients with severe disease. Effectiveness of laparoscopic magnetic sphincter augmentation (MSA) has not been extensively tested in patients with severe disease.Methods: A prospectively collected database was analyzed to identify patients who underwent MSA at a single institution. Individuals who had previous esophago-gastric surgery were excluded. Severe GERD was defined as lower esophageal sphincter pressure <5 mmHg, distal esophageal amplitude <30 mmHg, Barrett's metaplasia, stricture or grade C-D esophagitis, and/or DeMeester score >50. Clinical characteristics and outcomes of patients with severe GERD were compared with those of patients with mild to moderate GERD who served as control group.Results: Over the study period, a total of 336 patients met the inclusion criteria, and 102 (30.4%) had severe GERD. The median follow-up was 24 months (IQR = 75) in severe GERD patients and 32 months (IQR = 84) in those with non-severe GERD. Patients with severe GERD had a higher rate of dysphagia and higher GERD-HRQL scores. After the MSA procedure, symptoms, health-related quality of life scores, and proton-pump inhibitors consumption significantly decreased in both groups (p < 0.05). No difference between groups was found in the prevalence of severe post-operative dysphagia, the need for endoscopic dilation or device removal, and the DeMeester score.Conclusion: Laparoscopic MSA is safe and effective in reducing symptoms, PPI use, and esophageal acid exposure also in patients with severe GERD.

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Efficacy of Magnetic Sphincter Augmentation Across the Spectrum of GERD Disease Severity

Cited by 13 publications

References 38 publications

Comparing the Outcomes of MSA and Fundoplication in Severe GERD

Comparing the Outcomes of MSA and Fundoplication in Severe GERD

Magnetic sphincter augmentation device removal: surgical technique and results at medium-term follow-up

Magnetic Sphincter Augmentation Outcomes in Severe Gastroesophageal Reflux Disease

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