Skip to main content
SpringerLink
Log in

The role of preoperative workup in predicting dysphagia, dilation, or explantation after magnetic sphincter augmentation

  • 2020 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Magnetic sphincter augmentation (MSA) is a surgical treatment for gastroesophageal reflux disease using a ring of titanium beads to improve the function of the lower esophageal sphincter. Prior to implantation, a comprehensive preoperative esophageal workup is required to determine patient candidacy in an effort to reduce the dysphagia, dilation, and explantation rate of the device. This study was designed to assess the best predictors for these endpoints.

Methods

A prospectively maintained IRB-approved database was retrospectively reviewed for patients undergoing MSA implantation. Patients were divided into 3 groups, those that needed no intervention, those that needed medical intervention with oral steroids for reported dysphagia, and surgical intervention, which included endoscopic dilation and/or surgical explantation. Primary endpoints included preoperative objective and subjective testing from a comprehensive esophageal workup including intraoperative notation of number of beads on the device.

Results

There were 99 patients eligible for the study with a mean age of 52 and mean follow-up of 10.2 months. Mean BMI was 27 and 59% were female. The no-intervention group had 59 patients, medical intervention group had 25 patients, and surgical intervention group had 15 patients. Preoperative esophageal manometry findings, pH testing off medications, endoscopic and radiologic evaluation showed no difference between the 3 groups. No differences were seen in preoperative subjective evaluations based on GERD-HRQL or RSI scores. There was no difference in average number of beads on the device between the 3 groups.

Conclusion

A comprehensive esophageal workup is important to confirm the presence of gastroesophageal reflux disease and rule out other esophageal pathology. However, this study shows that a preoperative comprehensive esophageal workup does not predict which patients will develop dysphagia or require either medical or surgical interventions following MSA implantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ganz RA et al (2016) Long-term outcomes of patients receiving a magnetic sphincter augmentation device for gastroesophageal reflux. Clin Gastroenterol Hepatol 14(5):671–677

    Article  Google Scholar 

  2. Louie BE et al (2018) Objective evidence of reflux control after magnetic sphincter augmentation: one year results from a post approval study. Ann Surg 270:302–308

    Article  Google Scholar 

  3. Bell R et al (2019) Laparoscopic magnetic sphincter augmentation versus double-dose proton pump inhibitors for management of moderate-to-severe regurgitation in GERD: a randomized controlled trial. Gastrointest Endosc 89(1):14–22.e1

    Article  Google Scholar 

  4. Bonavina L et al (2008) Magnetic augmentation of the lower esophageal sphincter: results of a feasibility clinical trial. J Gastrointest Surg 12(12):2133–2140

    Article  Google Scholar 

  5. Buckley FP 3rd et al (2018) Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation. Surg Endosc 32(4):1762–1768

    Article  Google Scholar 

  6. Tatum JM et al (2019) Minimal versus obligatory dissection of the diaphragmatic hiatus during magnetic sphincter augmentation surgery. Surg Endosc 33(3):782–788

    Article  Google Scholar 

  7. Zhang H et al (2016) Revaluation of the efficacy of magnetic sphincter augmentation for treating gastroesophageal reflux disease. Surg Endosc 30(9):3684–3690

    Article  Google Scholar 

  8. Guidelines for surgical treatment of gastroesophageal reflux disease (GERD). Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Surg Endosc, 1998. 12(2): p. 186–8.

  9. Alicuben ET et al (2019) Routine esophageal manometry is not useful in patients with normal videoesophagram. Surg Endosc 33(5):1650–1653

    Article  Google Scholar 

  10. Schwameis K et al (2017) Post-Nissen dysphagia and bloating syndrome: outcomes after conversion to toupet fundoplication. J Gastrointest Surg 21(3):441–445

    Article  Google Scholar 

  11. Asti E et al (2017) Removal of the magnetic sphincter augmentation device: surgical technique and results of a single-center cohort study. Ann Surg 265(5):941–945

    Article  Google Scholar 

  12. Lipham JC et al (2015) Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease. Dis Esophagus 28(4):305–311

    Article  CAS  Google Scholar 

  13. Smith CD et al (2017) Lower esophageal sphincter augmentation for gastroesophageal reflux disease: the safety of a modern implant. J Laparoendosc Adv Surg Tech A 27(6):586–591

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA

    Steven G. Leeds & Marc A. Ward

  2. Department of Minimally Invasive Surgery, Baylor University Medical Center, 3500 Gaston Ave., Roberts Hospital, Dallas, TX, 75246, USA

    Steven G. Leeds, Eric M. Potter & Marc A. Ward

  3. Texas A&M University College of Medicine, Bryan, TX, USA

    Steven G. Leeds, Ahmed Ebrahim, Jessica S. Clothier & Marc A. Ward

  4. Baylor Scott & White Research Institute, Dallas, TX, USA

    Eric M. Potter, Purvi Prajapati & Gerald O. Ogola

Authors
  1. Steven G. Leeds
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmed Ebrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric M. Potter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jessica S. Clothier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Purvi Prajapati
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gerald O. Ogola
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marc A. Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven G. Leeds.

Ethics declarations

Disclosures

Dr. Steven G. Leeds reports non-financial support from Ethicon, outside the submitted work. Mr. Ahmed Ebrahim, Mr. Eric M. Potter, Ms. Jessica S. Clothier, Ms. Purvi Prajapati, Dr. Gerald O. Ogola, and Dr. Marc A. Ward have nothing to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leeds, S.G., Ebrahim, A., Potter, E.M. et al. The role of preoperative workup in predicting dysphagia, dilation, or explantation after magnetic sphincter augmentation. Surg Endosc 34, 3663–3668 (2020). https://doi.org/10.1007/s00464-020-07664-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07664-8

Keywords

Search

Navigation