Magnetic sphincter augmentation may be helpful in GERD

Last Updated: 2020-03-06

By David Douglas

NEW YORK (Reuters Health) - Magnetic sphincter augmentation (MSA) with the LINX device is associated with favorable clinical outcomes in gastroesophageal reflux disease (GERD), particularly in younger patients, according to a review of prospectively collected data.

"In the largest single-institution series, we demonstrated that MSA implantation is an effective and safe treatment for GERD," Dr. Shahin Ayazi of Allegheny Health Network, in Pittsburgh, Pennsylvania, told Reuters Health by email. "Patients reported significant improvement in GERD health-related quality of life after MSA implantation and about 90% of them discontinued daily use of anti-acid medications."

In a paper in the Journal of the American College of Surgery, Dr. Ayazi and colleagues note that MSA has the potential to overcome the limitations of fundoplication and has been broadly adopted by the surgical community.

The LINX device (Ethicon, Johnson and Johnson) applies magnetic force to augment the barrier function of an incompetent lower esophageal sphincter. This, say the researchers, "is a simple laparoscopic procedure, that does not alter gastric anatomy and can be easily reversed if needed."

To evaluate outcome in real-world applications across the spectrum of disease severity, the researchers studied data on 553 patients who underwent MSA at their institution between 2013 and 2018. All were at least 18 years old and had GERD or laryngopharyngeal reflux symptoms despite being prescribed maximal antisecretory therapy.

At a mean follow up of 10.3 months, 89.9% of the patients were free of proton-pump inhibitor use and 84% reported at least 50% improvement in their Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) total score. This score, which potentially ranges from 0 to 80, dropped from a baseline value of 33.8 to 7.2 (P<0.001).

Minor complications such as poor pain control and nausea were seen in 49 patients (8.9%). There were two major complications, one case of CO2 retention requiring re-intubation and one of mediastinal abscess requiring drainage and IV antibiotic.

Thirty-seven patients (6.7%) required removal of their device. Among major reasons for removal were dysphagia and chest pain.

Among independent predictors of a favorable outcome after the procedure were being less than 45 years of age (odds ratio, 4.2) being male (OR, 2.5) and having a GERD-HRQL total score of greater than 15.

"The finding of younger age as a predictor of successful outcome," concluded Dr. Ayazi, "highlights the importance of early surgical intervention in the management of reflux disease."

The authors report no funding for the study. One of Dr. Ayazi's coauthors is a paid consultant to Johnson & Johnson.

SOURCE: https://bit.ly/2TqCS0I Journal of the American College of Surgery, online February 15, 2020.