Magnetic sphincter augmentation in treating refractory gastroesophageal reflux disease: A systematic review and meta‐analysis

Abstract

Objective In this systematic review and meta‐analysis we aimed to determine the efficacy and safety of magnetic sphincter augmentation (MSA) in the management of refractory gastroesophageal reflux disease (rGERD). Methods Literature search was conducted in PubMed, the Cochrane Library, EMBASE, Web of Science, OpenGrey and ClincalTrials.gov for single‐arm studies evaluating the efficacy and safety of MSA in rGERD or comparative studies with proton pump inhibitor (PPI) or laparoscopic Nissen fundoplication (LNF) serving as the control published until April 2020. Primary outcome was the rate of postoperative PPI use, and secondary outcomes included postoperative GERD‐health‐related quality of life (GERD‐HRQL), normalization of acid exposure time (AET) and incidence of procedure‐related adverse events (AE). Results Ten single‐arm studies, one randomized controlled trial and three cohort studies involving 1138 participants were included. Post‐MSA PPI withdrawal, significant GERD‐HRQL improvement and AET normalization were achieved in 87.0%, 88.0% and 75.0% of the patients, respectively. The incidence of postoperative dysphagia was 29% and endoscopic dilation was required in 7.4% of patients undergoing MSA. MSA showed a better efficacy in symptom control than PPI (PPI cessation: 91% vs 0%; GERD‐HRQL improvement: 81% vs 8%) and similar effectiveness but a lower risk of gas‐bloat syndrome (risk ratio [RR] 0.69, 95% confidence interval [CI] 0.51‐0.93, P = 0.01) and better reserved ability to belch (RR 1.48, 95% CI 0.76‐2.86, P = 0.25) compared with LNF. Conclusions MSA was an effective and safe therapy for rGERD. Well‐designed randomized trials that compare the efficacy of MSA with other therapies are needed.

Study on the Effect of Different Endoscopic Auxiliary Treatment of Gastric Mucosal Microtumor

“…Conventional laparotomy is the most important and effective treatment for large gastric submucosal tumors [ 22 ]. Endoscopic treatment is mainly used for patients with small submucosal tumors (< 20 mm), of which endoscopic submucosal tumor resection is more effective and less risky for submucosal tumors with diameters of 10–20 mm, endoscopic mucosal resection is a minimally invasive procedure for the treatment of submucosal tumors of the gastrointestinal tract, the utility model has the advantages of accurate positioning, high block resection rate, reducing the chance of residual and recurrence, realizing radical treatment, less trauma, few complications, no change of the structure of the digestive tract, safety and effectiveness in treating the pathological changes of the digestive tract and so on [ 23 , 24 ].…”