Abstract
Magnetic sphincter augmentation with the LINX® Reflux Management System is a novel device made of an expansible bracelet of magnetic beads designed to be placed around the gastroesophageal junction with a standardized laparoscopic procedure. This device can augment the function of the lower esophageal sphincter by preventing premature opening of the sphincter, thereby preventing reflux of gastric contents into the lower esophagus, while maintaining the ability to permit the passage of the food bolus and to belch and vomit. Magnetic sphincter augmentation has demonstrated in multiple studies consistent improvements in patient symptoms as measured by the GERD-HRQL instrument, freedom from PPIs, and improving objective pH control. These outcomes confirm that MSA is an effective method of controlling troublesome GERD symptoms. Future studies are required to determine its role outside of the initial indications for its use.
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References
Nissen R. Eine einfache Operation zur Beeinflussung der Refluxoesophagitis. Schweiz Med Wochenschr. 1956;86:590–2.
Lundell L, Miettinen P, Myrvold H, Pedersen S, Liedman B, Hatlebakk J, et al. Continued (5-year) followup of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease. Am Coll Surg [Internet]. 2001;192(2):172–9. Available from: http://www.sciencedirect.com/science/article/pii/S1072751500007973.
Lundell L, Miettinen P, Myrvold HE, Hatlebakk JG, Wallin L, Engström C, et al. Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis. Clin Gastroenterol Hepatol [Internet]. 2009;7(12):1292–8. Available from: https://doi.org/10.1016/j.cgh.2009.05.021.
Galmiche J-P, Hatlebakk J, Attwood S, Ell C, Fiocca R, Eklund S, et al. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD. JAMA [Internet]. 2011;305(19):1969–77. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2011.626.
Angelchik JP, Cohen R. A new surgical procedure for the treatment of gastroesophageal reflux and hiatal hernia. Surg Gynecol Obstet [Internet]. 1979;148(2):246–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/154176.
Samelson SL, Weiser HF, Bombeck CT, Siewert JR, Ludtke FE, Hoelscher AH, et al. A new concept in the surgical treatment of gastroesophageal reflux. Ann Surg [Internet]. 1983;197(3):254–9. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1352726&tool=pmcentrez&rendertype=abstract.
Ganz RA, Gostout CJ, Grudem J, Swanson W, Berg T, DeMeester TR. Use of a magnetic sphincter for the treatment of GERD: a feasibility study. Gastrointest Endosc. 2008;67(2):287–94.
Bonavina L, Saino GI, Bona D, Lipham J, Ganz RA, Dunn D, et al. Magnetic augmentation of the lower esophageal sphincter: results of a feasibility clinical trial. J Gastrointest Surg. 2008;12(12):2133–40.
Bonavina L, DeMeester T, Fockens P, Dunn D, Saino G, Bona D, et al. Laparoscopic sphincter augmentation device eliminates reflux symptoms and normalizes esophageal acid exposure. Ann Surg. 2010;252(5):857–62.
Lipham JC, DeMeester TR, Ganz RA, Bonavina L, Saino G, Dunn DH, et al. The LINX® reflux management system: confirmed safety and efficacy now at 4 years. Surg Endosc Other Interv Tech. 2012;26(10):2944–9.
Saino G, Bonavina L, Lipham JC, Dunn D, Ganz RA. Magnetic sphincter augmentation for gastroesophageal reflux at 5 years: final results of a pilot study show long-term acid reduction and symptom improvement. J Laparoendosc Adv Surg Tech A [Internet]. 2015;25(10):787–92. Available from: http://www.scopus.com/inward/record.url?eid=2-s2.0-84945588819&partnerID=tZOtx3y1.
Ganz RA, Peters JH, Horgan S, et al. Esophageal sphincter device for gastroesophageal reflux disease. N Engl J Med. 2013;368(8):719–27. http://www.ncbi.nlm.nih.gov/pubmed/23425164
Bonavina L, Saino G, Bona D, Sironi A, Lazzari V. One hundred consecutive patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease: 6 years of clinical experience from a single center. J Am Coll Surg [Internet]. 2013;217(4):577–85. Available from: https://doi.org/10.1016/j.jamcollsurg.2013.04.039.
Lipham JC, Taiganides PA, Louie BE, Ganz RA, Demeester TR. Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease. Dis Esophagus. 2015;28(4):305–11.
Smith CD, Ganz RA, Lipham JC, Bell RC, Rattner DW. Lower esophageal sphincter augmentation for gastroesophageal reflux disease: the safety of a modern implant. J Laparoendosc Adv Surg Tech [Internet]. 2017;27(6):lap.2017.0025. Available from: http://online.liebertpub.com/doi/10.1089/lap.2017.0025.
Czosnyka NM, Buckley FP, Doggett SL, Vassaur H, Connolly EE, Borgert AJ, et al. Outcomes of magnetic sphincter augmentation – a community hospital perspective. Am J Surg. 2016;213:1019.
Bauer M, Meining A, Kranzfelder M, Jell A, Schirren R, Wilhelm D, et al. Endoluminal perforation of a magnetic antireflux device. Surg Endosc Other Interv Tech [Internet]. 2015;29(12):3806–10. Available from: https://doi.org/10.1007/s00464-015-4145-6.
Ganz RA, Edmundowicz SA, Taiganides PA, Lipham JC, Smith CD, DeVault KR, et al. Long-term outcomes of patients receiving a magnetic sphincter augmentation device for gastroesophageal reflux. Clin Gastroenterol Hepatol [Internet]. 2016;14(5):671–7. Available from: https://doi.org/10.1016/j.cgh.2015.05.028.
Reynolds JL, Zehetner J, Wu P, Shah S, Bildzukewicz N, Lipham JC. Laparoscopic magnetic sphincter augmentation vs laparoscopic nissen fundoplication: a matched-pair analysis of 100 patients. J Am Coll Surg [Internet]. 2015;221(1):123–8. Available from: https://doi.org/10.1016/j.jamcollsurg.2015.02.025.
Louie BE, Farivar AS, Shultz D, Brennan C, Vallières E, Aye RW. Short-term outcomes using magnetic sphincter augmentation versus nissen fundoplication for medically resistant gastroesophageal reflux disease. Ann Thorac Surg. 2014;98(2):498–505.
Riegler M, Schoppman SF, Bonavina L, Ashton D, Horbach T, Kemen M. Magnetic sphincter augmentation and fundoplication for GERD in clinical practice: one-year results of a multicenter, prospective observational study. Surg Endosc. 2015;29:1123–9.
Sheu EG, Nau P, Nath B, Kuo B, Rattner DW. A comparative trial of laparoscopic magnetic sphincter augmentation and Nissen fundoplication. Surg Endosc. 2015;29(3):505–9.
Asti E, Bonitta G, Lovece A, Lazzari V, Bonavina L. Longitudinal comparison of quality of life in patients undergoing laparoscopic Toupet fundoplication versus magnetic sphincter augmentation: observational cohort study with propensity score analysis. Medicine (Baltimore). 2016;95(30):e4366.
Warren HF, Reynolds JL, Lipham JC, Zehetner J, Bildzukewicz NA, Taiganides PA, et al. Multi-institutional outcomes using magnetic sphincter augmentation versus Nissen fundoplication for chronic gastroesophageal reflux disease. Surg Endosc Other Interv Tech. 2016;30(8):3289–96.
Lord RVN, Demeester SR, Peters JH, Hagen JA, Elyssnia D, Sheth CT, et al. Hiatal hernia, lower esophageal sphincter incompetence, and effectiveness of nissen fundoplication in the spectrum of gastroesophageal reflux disease. J Gastrointest Surg. 2009;13(4):602–10.
Crookes PF, Ritter MP, Johnson WE, Bremner CG, Peters JH, DeMeester TR. Static and dynamic function of the lower esophageal sphincter before and after laparoscopic Nissen fundoplication. J Gastrointest Surg. 1997;1(6):499–504.
Warren HF, Louie BE, Farivar AS, Wilshire C, Aye RW. Manometric changes to the lower esophageal sphincter after magnetic sphincter augmentation in patients with chronic gastroesophageal reflux disease. Ann Surg [Internet]. 2016;266(1):99. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-900000000-96487.
Warren HF, Brown LM, Mihura M, Farivar AS, Aye RW, Louie BE. Factors influencing the outcome of magnetic sphincter augmentation for chronic gastroesophageal reflux disease. Surg Endosc. 2018;32(1):405–12.
Wu JC-Y, Mui L-M, Cheung CM-Y, Chan Y, Sung JJ-Y. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007;132(3):883–9.
El-Serag HB, Ergun GA, Pandolfino J, Fitzgerald S, Tran T, Kramer JR. Obesity increases oesophageal acid exposure. Gut. 2007;56(6):749–55.
Ayazi S, Hagen JA, Zehetner J, Ross O, Wu C, Oezcelik A, et al. The value of high-resolution manometry in the assessment of the resting characteristics of the lower esophageal sphincter. J Gastrointest Surg. 2009;13(12):2113–20.
Quiroga E, Cuenca-Abente F, Flum D, Dellinger EP, Oelschlager BK. Impaired esophageal function in morbidly obese patients with gastroesophageal reflux disease: evaluation with multichannel intraluminal impedance. Surg Endosc Other Interv Tech. 2006;20(5):739–43.
Rona KA, Reynolds J, Schwameis K, Zehetner J, Samakar K, Oh P, et al. Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias. Surg Endosc Other Interv Tech. 2016;31(5):1–7.
Bell RCW, Buckely FP III, Freeman K, Doggett S, Heidrick R. Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation. Surg Endosc. 2017;32:1762.
Thor KB, Hill LD, Mercer DD, Kozarek RD. Reappraisal of the flap valve mechanism in the gastroesophageal junction. A study of a new valvuloplasty procedure in cadavers. Acta Chir Scand. 1987;153(1):25–8.
Marchand P. The gastro-oesophageal “sphincter” and the mechanism of regurgitation. Br J Surg. 1955;42:504–13.
Desart K, Rossidis G, Michel M, Lux T, Ben-David K. Gastroesophageal reflux management with the LINX® system for gastroesophageal reflux disease following laparoscopic sleeve gastrectomy. J Gastrointest Surg. 2015;19(10):1782–6.
Muñoz-Largacha JA, Hess DT, Litle VR, Fernando HC. Lower esophageal magnetic sphincter augmentation for persistent reflux after Roux-en-Y gastric bypass. Obes Surg. 2016;26(2):464–6.
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Mihura, M., Louie, B.E. (2019). Laparoscopic Antireflux Surgery: Magnetic GEJ Augmentation. In: Grams, J., Perry, K., Tavakkoli, A. (eds) The SAGES Manual of Foregut Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-96122-4_13
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DOI: https://doi.org/10.1007/978-3-319-96122-4_13
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