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. 2021 Nov 2:8:645592.
doi: 10.3389/fmed.2021.645592. eCollection 2021.

Magnetic Sphincter Augmentation Outcomes in Severe Gastroesophageal Reflux Disease

Davide Ferrari  1 , Stefano Siboni  1 , Carlo Galdino Riva  1 , Guglielmo Guerrazzi  1 , Andrea Lovece  1 , Luigi Bonavina  1
Affiliations

Magnetic Sphincter Augmentation Outcomes in Severe Gastroesophageal Reflux Disease

Davide Ferrari et al. Front Med (Lausanne). .

Abstract

Introduction: Outcomes of laparoscopic procedures for gastroesophageal reflux disease (GERD) are variable depending on surgical expertise and/or patient-related factors. Some procedures may be inadequate in patients with severe disease. Effectiveness of laparoscopic magnetic sphincter augmentation (MSA) has not been extensively tested in patients with severe disease. Methods: A prospectively collected database was analyzed to identify patients who underwent MSA at a single institution. Individuals who had previous esophago-gastric surgery were excluded. Severe GERD was defined as lower esophageal sphincter pressure <5 mmHg, distal esophageal amplitude <30 mmHg, Barrett's metaplasia, stricture or grade C-D esophagitis, and/or DeMeester score >50. Clinical characteristics and outcomes of patients with severe GERD were compared with those of patients with mild to moderate GERD who served as control group. Results: Over the study period, a total of 336 patients met the inclusion criteria, and 102 (30.4%) had severe GERD. The median follow-up was 24 months (IQR = 75) in severe GERD patients and 32 months (IQR = 84) in those with non-severe GERD. Patients with severe GERD had a higher rate of dysphagia and higher GERD-HRQL scores. After the MSA procedure, symptoms, health-related quality of life scores, and proton-pump inhibitors consumption significantly decreased in both groups (p < 0.05). No difference between groups was found in the prevalence of severe post-operative dysphagia, the need for endoscopic dilation or device removal, and the DeMeester score. Conclusion: Laparoscopic MSA is safe and effective in reducing symptoms, PPI use, and esophageal acid exposure also in patients with severe GERD.

Keywords: Barrett's esophagus; DeMeester score; esophagitis; gastroesophageal reflux disease; hiatus hernia; magnetic sphincter augmentation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Combination of pre-operative abnormalities in patients with severe GERD. DM, DeMeester Score; BE, Barrett's Esophagus; LES P, LES residual pressure; DEA, Distal esophageal aperistalsis.
Figure 2
Figure 2
GERD-HRQL scores before and after laparoscopic MSA in patients with or without severe GERD. GERD-HRQL, gastroesophageal reflux disease health-related quality of life; MSA, magnetic sphincter augmentation; GERD, gastro-esophageal reflux disease; *p < 0.05.
Figure 3
Figure 3
PPI consumption before and after MSA procedure in patients with or without severe GERD. PPI, proton-pump inhibitors; MSA, magnetic sphincter augmentation; GERD, gastro-esophageal reflux disease; *p < 0.05.
Figure 4
Figure 4
Post-operative outcomes in patients with severe or non severe GERD. PPI, proton-pump inhibitors; AET, acid exposure time; DM, DeMeester score; GERD, gastro-esophageal reflux disease; *p < 0.05.
Figure 5
Figure 5
DeMeester score in patients with severe or non severe GERD before and after MSA procedure. MSA, magnetic sphincter augmentation; GERD, gastro-esophageal reflux disease; *p < 0.05.
See this image and copyright information in PMC

References

    1. Nirwan JS, Hasan SS, Babar ZUD, Conway BR, Ghori MU. Global prevalence and risk factors of gastro-oesophageal reflux disease (GORD): systematic review with meta-analysis. Sci Rep. (2020) 10:1–14. 10.1038/s41598-020-62795-1 - DOI - PMC - PubMed
    1. Watson DI, Baigrie RJ, Jamieson GG. A learning curve for laparoscopic fundoplication definable, avoidable, or a waste of time? Ann Surg. (1996) 224:198–203. 10.1097/00000658-199608000-00013 - DOI - PMC - PubMed
    1. Gill J, Booth MI, Stratford J, Dehn TCB. The extended learning curve for laparoscopic fundoplication: a cohort analysis of 400 consecutive cases. J Gastrointest Surg. (2007) 11:487–92. 10.1007/s11605-007-0132-0 - DOI - PMC - PubMed
    1. Bona D, Aiolfi A, Asti E, Bonavina L. Laparoscopic Toupet fundoplication for gastroesophageal reflux disease and hiatus hernia: proposal for standardization using the “critical view” concept. Updates Surg. (2020) 72:555–8. 10.1007/s13304-020-00732-7 - DOI - PubMed
    1. Ferrari D, Asti E, Lazzari V, Siboni S, Bernardi D, Bonavina L. Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease. Sci Rep. (2020) 10:13753. 10.1038/s41598-020-70742-3 - DOI - PMC - PubMed