Magnetic sphincter augmentation: Optimal patient selection and referral care pathways

Friedel, David

doi:10.4253/wjge.v11.i8.443

Cited by 11 publications

(10 citation statements)

References 106 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…118 The LINX R MSA system provides 15-25 mmHg pressure at the LES that exceeds gastric pressures (5-10 mmHg) but is easily overcome by peristaltic pressure (35-80 mmHg). 117,119 MSA leads to a similar improvement in HR-QOL scores when compared with fundoplication surgery and has been demonstrated to be safe and reversible and is associated with fewer side effects. 120 The LINX R system can lead to esophageal erosion or formation of a fibrotic capsule around the ring, leading to dysphagia.…”

Section: Novel Surgical Alternativesmentioning

confidence: 94%

“…It was designed to address a therapy gap for patients, with disease inadequately controlled by medical therapy, who did not want to undergo a fundoplication with its associated side effects and is easily reversible if needed 118 . The LINX® MSA system provides 15–25 mmHg pressure at the LES that exceeds gastric pressures (5–10 mmHg) but is easily overcome by peristaltic pressure (35–80 mmHg) 117,119 . MSA leads to a similar improvement in HR‐QOL scores when compared with fundoplication surgery and has been demonstrated to be safe and reversible and is associated with fewer side effects 120 .…”

Section: Novel Surgical Alternativesmentioning

confidence: 99%

See 1 more Smart Citation

Rethinking gastroesophageal reflux disorder

Banting

Badgery

Read

et al. 2020

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

Gastroesophageal reflux disease (GERD) is a common clinical condition for which our understanding has evolved over the past decades. It is now considered a cluster of phenotypes with numerous anatomical and physiological abnormalities contributing to its pathophysiology. As such, it is important to first understand the underlying mechanism of the disease process for each patient before embarking on therapeutic interventions. The aim of our paper is to highlight the mechanisms contributing to GERD and review investigations and interpretation of these results. Finally, the paper reviews the available treatment modalities for this condition, ranging from medical intervention, endoscopic options through to surgery and its various techniques.

show abstract

Section: Novel Surgical Alternativesmentioning

confidence: 94%

Section: Novel Surgical Alternativesmentioning

confidence: 99%

Rethinking gastroesophageal reflux disorder

Banting

Badgery

Read

et al. 2020

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

show abstract

“…It is our estimate that in our HBC, as many as 20% of patient referrals may have been lost if GIs were not integrated into the HBC. However, to ensure timely referrals and to avoid referrals from GIs that are only limited to those patients with long-term, severe symptoms and large hiatal hernias, improved education for recognizing symptoms suggestive of GERD, and consequently to appropriately channel patients through diagnostic and treatment pathways ( 22 ).…”

Section: Methodsmentioning

confidence: 99%

Heartburn Center Set-Up in a Community Setting: Engineering and Execution

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background: Optimal management of gastroesophageal reflux disease (GERD) requires a concerted team of physicians rather than an individual approach. While an integrated approach to GERD has previously been proposed, the practical execution of such a “center of excellence” (COE) has not been described, particularly in a community setting. Ranging from initial consultation and diagnosis to surgical intervention for complex disease, such an approach is likely to provide optimal care and provide surveillance for patients with a complex disease process of GERD.Methods: We report our approach to implement an integrated heartburn center (HBC) and our experience with the first cohort of patients. Patients treated in the HBC were followed for 2 years from initial consultation to completion of their appropriate treatment plan, including anti-reflux surgery. The performance prior to the HBC set-up was compared to that post-HBC. Performance was measured in terms of volume of patients referred, referral patterns, length of stay (LOS), and patient health-related quality of life (HRQL) pre- and post-surgery.Results: Setting up the HBC resulted in referrals from multiple avenues, including primary care physicians (PCPs), emergency departments (EDs), and gastroenterologists (GIs). There was a 75% increase in referrals compared to pre-center patient volumes. Among the initial cohort of 832 patients presenting to the HBC, <10% had GERD for <1 year, ~60% had GERD for 1–11 years, and ~30% had GERD for ≥12 years. More than one-quarter had atypical GERD symptoms (27.6%). Only 6.4% had been on PPIs for <1 year and >20% had been on PPIs for ≥12 years. Thirty-eight patients were found to have Barrett's esophagus (4.6%) (up to 10 times the general population prevalence). Two patients had dysplasia. Seven patients (0.8%) received radiofrequency ablation (RFA) for Barrett's esophagus and two patients received endoscopic mucosal resection (EMR) for Barrett's esophagus-related dysplasia. The most common comorbidities were chronic pulmonary disease (16.8%) and diabetes without complications (10.6%). Patients received treatment for newly identified comorbid conditions, including early maladaptive schemas (EMS) and generalized anxiety disorder (GAD) (n = 7; 0.8%). Fifty cases required consultation with various specialists (6.0%) and 34 of those (4.1%) resulted in changes in care. Despite the significant increase in patient referrals, conversion rates from diagnosis to anti-reflux surgery remained consistent at ~25%. Overall HRQL improved year-over-year, and LOS was significantly reduced with potential cost savings for the larger institution.Conclusions: While centralization of GERD care is known to improve outcomes, in this case study we demonstrated the clinical success and commercial viability of centralizing GERD care in a community setting. The integrated GERD service line center offered a comprehensive, multi-specialty, and coordinated patient-centered approach. The approach is reproducible and may allow hospitals to set up their own heartburn COEs, strengthening patient-community relationships and establishing scientific and clinical GERD leadership.

show abstract

“…MSA has been shown to be as safe and effective as LNF, but with lower rates of postoperative gas-bloating syndrome and inability to belch and/or vomit in studies so far [2,[16][17][18][19][20]. The rate of postoperative dysphagia varies with the follow-up: Acute postoperative dysphagia is common and affects approximately 30% of all patients, while longterm dysphagia rates drop to 7% after 3 years [15,[21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Severe Dysphagia is Rare After Magnetic Sphincter Augmentation

et al. 2022

View full text Add to dashboard Cite

Background Dysphagia remains the most significant concern after anti-reflux surgery, including magnetic sphincter augmentation (MSA). The aim of this study was to evaluate postoperative dysphagia rates, its risk factors, and management after MSA. Methods From a prospectively collected database of all 357 patients that underwent MSA at our institution, a total of 268 patients were included in our retrospective study. Postoperative dysphagia score, gastrointestinal symptoms, proton pump inhibitor intake, GERD-HRQL, Alimentary Satisfaction, and serial contrast swallow imaging were evaluated within standardized follow-up appointments. To determine patients’ characteristics and surgical factors associated with postoperative dysphagia, a multivariable logistic regression analysis was performed. Results At a median follow-up of 23 months, none of the patients presented with severe dysphagia, defined as the inability to swallow solids or/and liquids. 1% of the patients underwent endoscopic dilatation, and 1% had been treated conservatively for dysphagia. 2% of the patients needed re-operation, most commonly due to recurrent hiatal hernia. Two patients underwent device removal due to unspecific discomfort and pain. No migration of the device or erosion by the device was seen. The LINX® device size ≤ 13 was found to be the only factor associated with postoperative dysphagia (OR 5.90 (95% CI 1.4–24.8)). The postoperative total GERD-HRQL score was significantly lower than preoperative total score (2 vs. 19; p = 0.001), and daily heartburn, regurgitations, and respiratory complains improved in 228/241 (95%), 131/138 (95%) and 92/97 (95%) of patients, respectively. Conclusions Dysphagia requiring endoscopic or surgical intervention was rare after MSA in a large case series. LINX® devices with a size < 13 were shown to be an independent risk factor for developing postoperative dysphagia.

show abstract

Magnetic sphincter augmentation: Optimal patient selection and referral care pathways

Cited by 11 publications

References 106 publications

Rethinking gastroesophageal reflux disorder

Rethinking gastroesophageal reflux disorder

Heartburn Center Set-Up in a Community Setting: Engineering and Execution

Severe Dysphagia is Rare After Magnetic Sphincter Augmentation

Contact Info

Product

Resources

About