Magnetic Sphincter Augmentation After Gastric Surgery

Riva, Carlo Galdino; Asti, Emanuele; Lazzari, Veronica; Aquilino, Krizia; Siboni, Stefano; Bonavina, Luigi

doi:10.4293/jsls.2019.00035

Cited by 21 publications

(10 citation statements)

References 36 publications

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“…MSA also seems to have a role in the treatment of GERD that worsens or develops after bariatric operations such as sleeve gastrectomy and RYGB (218). These operations alter gastric anatomy in a way that can preclude performance of a standard fundoplication.…”

Section: Surgical and Endoscopic Options For Gerdmentioning

confidence: 99%

ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease

et al. 2021

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Gastroesophageal reflux disease (GERD) continues to be among the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing, and approach to patient management have evolved. During this time, scrutiny of proton pump inhibitors (PPIs) has increased considerably. Although PPIs remain the medical treatment of choice for GERD, multiple publications have raised questions about adverse events, raising doubts about the safety of long-term use and increasing concern about overprescribing of PPIs. New data regarding the potential for surgical and endoscopic interventions have emerged. In this new document, we provide updated, evidence-based recommendations and practical guidance for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic management. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to evaluate the evidence and the strength of recommendations. Key concepts and suggestions that as of this writing do not have sufficient evidence to grade are also provided.

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Section: Surgical and Endoscopic Options For Gerdmentioning

confidence: 99%

ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease

et al. 2021

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“…When complication rates are compared, those having MSA de novo versus those after prior sleeve gastrectomy showed no difference in serious adverse events [8,9]. When minor events were reviewed, even the dysphagia seen in this IDE trial resolved quickly (see table below).…”

Section: Discussionmentioning

confidence: 85%

“…Magnetic sphincter augmentation (MSA), utilizing the LINX Reflux Management System (LINX), has been considered an alternative treatment option for patients experiencing GERD symptoms post-LSG [7][8][9][10][11]. LINX is a fundic-sparing anti-reflux device placed laparoscopically around the esophagus at the level of the lower esophageal sphincter (LES) (Fig.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Efficacy of Magnetic Sphincter Augmentation for the Management of Gastroesophageal Reflux Disease Post-Sleeve Gastrectomy for Obesity

Khaitan

Hill

Michel³

et al. 2022

OBES SURG

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Background Patients with medically intractable GERD after laparoscopic sleeve gastrectomy (LSG) have limited surgical options. Fundoplication is difficult post-LSG. Roux-en-Y gastric bypass may be used as a conversion procedure but is more invasive with potential for serious complications. Magnetic sphincter augmentation (MSA) is a less invasive GERD treatment alternative. The objective of this study was to assess safety and efficacy outcomes of MSA after LSG. Methods The primary outcome of this observational, multicenter, single-arm prospective study was the rate of serious device and/or procedure-related adverse events (AEs). The efficacy of the LINX device was measured comparing baseline to 12-month post-implant reductions in distal acid exposure, GERD-HRQL score, and average daily PPI usage. Results Thirty subjects who underwent MSA implantation were followed 12 months post-implant. No unanticipated adverse device effects were observed. There were two adverse events deemed serious (dysphagia, pain, 6.7%) which resolved without sequelae. GERD-HRQL scores showed significant improvement (80.8%, P < 0.001), and reduction in daily PPI usage was seen (95.8%, P < 0.001). Forty-four percent of subjects demonstrated normalization or > = 50% reduction of total distal acid exposure time (baseline 16.2%, 12 months 11%; P = 0.038). Conclusions Post-LSG, MSA showed an overall improvement of GERD symptoms, and reduction in PPI use with explants within anticipated range along with improvement in distal esophageal acid exposure time. Graphical Abstract

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“…They evaluated 23 patients by means of magnetic resonance imaging and HRM before and after surgery and realized that LES length was reduced after SG, aggravating our findings, where even 36.2% of asymptomatic patients had a structurally defective LES prior to surgery. Moreover, disruption of the esophagogastric junction and small gastric capacity were associated with the risk of postoperative GERD leading to concepts of novel sphincter augmentation devices being implemented for these patients [16]. Therefore, it seems reasonable that preoperative assessment of LES function could help us tailor our surgical decision-making to prevent additional damage to an already injured sphincter.…”

Section: Discussionmentioning

confidence: 99%

Silent Gastroesophageal Reflux Disease in Patients with Morbid Obesity Prior to Primary Metabolic Surgery

et al. 2020

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Purpose Long-term follow-up after sleeve gastrectomy (SG) revealed a high incidence of gastroesophageal reflux disease (GERD) frequently caused by preoperative silent pathologic reflux. We aimed to evaluate prevalence and phenotypes of GERD in asymptomatic patients with morbid obesity prior to metabolic surgery according to modern objective testing. Material and Methods Prospective collection of data including consecutive patients with morbid obesity (body mass index (BMI) ≥ 35 kg/m2) prior to metabolic surgery was applied for this study between 2014 and 2019. Patients underwent clinical examinations, endoscopy, pH metry, and high-resolution manometry and were analyzed according to the Lyon consensus. Results Of 1379 patients undergoing metabolic surgery, 177 (12.8%, females = 105) asymptomatic individuals with a median age of 42.6 (33.8; 51.6) years and a median BMI of 44.6 (41.3; 50.8) kg/m2 completed objective testing and were included during the study period. GERD was diagnosed in 55 (31.1%), whereas criteria of borderline GERD were met in another 78 (44.1%). GERD was mediated by a structural defective lower esophageal sphincter (p = 0.004) and highlighted by acidic (p = 0.004) and non-acidic (p = 0.022) reflux episodes. Esophageal motility disorders were diagnosed in 35.6% (n = 63) of individuals with a novel hypercontractile disorder found in 7.9% (n = 14) of patients. Conclusion GERD affects a majority of asymptomatic patients with morbid obesity prior to primary bariatric surgery. Future longitudinal trials will have to reveal the clinical significance of esophageal motility disorders in patients with morbid obesity.

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Magnetic Sphincter Augmentation After Gastric Surgery

Cited by 21 publications

References 36 publications

ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease

ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease

Feasibility and Efficacy of Magnetic Sphincter Augmentation for the Management of Gastroesophageal Reflux Disease Post-Sleeve Gastrectomy for Obesity

Silent Gastroesophageal Reflux Disease in Patients with Morbid Obesity Prior to Primary Metabolic Surgery

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