Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Oct 1;110(10):6355-6366.
doi: 10.1097/JS9.0000000000001558.

Magnetic sphincter augmentation in the management of gastro-esophageal reflux disease: a systematic review and meta-analysis

Michael G Fadel  1   2 , Munir Tarazi  1 , Madhav Dave  3 , Marcus Reddy  4 , Omar Khan  4   5 , Naim Fakih-Gomez  2 , Hutan Ashrafian  1 , Matyas Fehervari  1   6
Affiliations
Meta-Analysis

Magnetic sphincter augmentation in the management of gastro-esophageal reflux disease: a systematic review and meta-analysis

Michael G Fadel et al. Int J Surg. .

Abstract

Background: Magnetic sphincter augmentation (MSA) through placement of the LINX device is an alternative to fundoplication in the management of gastro-esophageal reflux disease (GERD). This systematic review and meta-analysis aimed to assess efficacy, quality of life, and safety in patients that underwent MSA, with a comparison to fundoplication.

Methods: A literature search of MEDLINE, Embase, Emcare, Scopus, Web of Science, and Cochrane library databases was performed for studies that reported data on outcomes of MSA, with or without a comparison group undergoing fundoplication, for GERD from January 2000 to January 2023. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed.

Results: Thirty-nine studies with 8075 patients were included: 6983 patients underwent MSA and 1092 patients had laparoscopic fundoplication procedure. Ten of these studies (seven retrospective and three prospective) directly compared MSA with fundoplication. A higher proportion of individuals successfully discontinued proton-pump inhibitors ( P <0.001; WMD 0.83; 95% CI: 0.72-0.93; I2 =96.8%) and had higher patient satisfaction ( P <0.001; WMD 0.85; 95% CI: 0.78-0.93; I2 =85.2%) following MSA when compared to fundoplication. Functional outcomes were better after MSA than after fundoplication including ability to belch ( P <0.001; WMD 0.96; 95% CI: 0.93-0.98; I2 =67.8) and emesis ( P <0.001; WMD 0.92; 95% CI: 0.89-0.95; I2 =42.8%), and bloating ( P =0.003; WMD 0.20; 95% CI: 0.07-0.33; I2 =97.0%). MSA had higher rates of dysphagia ( P =0.001; WMD 0.41; 95% CI: 0.17-0.65; I2 =97.3%) when compared to fundoplication. The overall erosion and removal rate following MSA was 0.24% and 3.9%, respectively, with no difference in surgical reintervention rates between MSA and fundoplication ( P =0.446; WMD 0.001; 95% CI: -0.001-0.002; I2 =78.5%).

Conclusions: MSA is a safe and effective procedure at reducing symptom burden of GERD and can potentially improve patient satisfaction and functional outcomes. However, randomized controlled trials directly comparing MSA with fundoplication are necessary to determine where MSA precisely fits in the management pathway of GERD.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
The flowchart shows the literature search and study selection process according to the PRISMA guidelines.
Figure 2
Figure 2
(A) Weighted mean of PPI discontinuation following MSA. (B) Meta-analysis and forest plot of studies comparing PPI discontinuation following MSA and fundoplication.
Figure 3
Figure 3
(A) Meta-analysis and forest plot of studies comparing GERD-HRQL following MSA and fundoplication. (B) Weighted mean of patient satisfaction following MSA. (C) Meta-analysis and forest plot of studies comparing patient satisfaction following MSA and fundoplication.
Figure 4
Figure 4
Meta-analysis and forest plot of studies comparing weighted mean difference of (A) operative time and (B) length of stay following MSA and fundoplication.
Figure 5
Figure 5
Meta-analysis and forest plot of studies of weighted mean of (A) dysphagia following MSA. Meta-analysis and forest plot of studies comparing weighted mean difference of (B) dysphagia and (C) endoscopic dilatation following MSA and fundoplication.
Figure 6
Figure 6
Meta-analysis and forest plot of studies assessing (A) ability to belch, (B) ability to emesis, (C) bloating following MSA and fundoplication treatment.
Figure 7
Figure 7
Meta-analysis and forest plot of studies assessing (A) erosions and (B) removal of MSA device.
See this image and copyright information in PMC

References

    1. Danilova DA, Bazaev AV, Gorbunova LI. Current aspects of surgical treatment of gastro-esophageal reflux disease. Khirurgiia (Mosk) 2020;2:89–94. - PubMed
    1. Schizas D, Mastoraki A, Papoutsi E, et al. . LINX((R)) reflux management system to bridge the “treatment gap” in gastresophageal reflux disease: A systematic review of 35 studies. World J Clin Cases 2020;8:294–305. - PMC - PubMed
    1. Yamasaki T, Hemond C, Eisa M, et al. . The changing epidemiology of gastresophageal reflux disease: are patients getting younger? J Neurogastroenterol Motil 2018;24:559–569. - PMC - PubMed
    1. Markar SR, Arhi C, Leusink A, et al. . The influence of antireflux surgery on esophageal cancer risk in England: national population-based cohort study. Ann Surg 2018;268:861–867. - PubMed
    1. Fass R, Sifrim D. Management of heartburn not responding to proton pump inhibitors. Gut 2009;58:295–309. - PubMed

LinkOut - more resources