Abstract
Background
Untreated gastroesophageal reflux disease (GERD) can lead to Barrett’s esophagus and an increased risk for esophageal adenocarcinoma. Magnetic sphincter augmentation (MSA) is a safe and effective modality for the treatment of GERD. Preliminary research on short-term outcomes after MSA demonstrated significant regression of Barrett’s. Further investigation is required to evaluate the long-term effect of this treatment.
Methods
A retrospective review of patients was conducted with biopsy-proven Barrett’s esophagus who underwent MSA between 2007 and 2019. As a part of their preoperative evaluation, patients underwent esophagogastroduodenoscopy (EGD) with biopsies of the distal esophagus and gastroesophageal junction including any abnormal-appearing segments, pH testing, and a videoesophagram. Patients were categorized according to the length of Barrett’s identified (ultrashort < 1 cm, short 1–3 cm, long > 3 cm). Improvement was defined as a decrease in length (e.g. long to short).
Results
There were 87 patients identified for study inclusion. 55 patients were male. The median body mass index was 26.95. The median age was 61.81 (49.79–68.29). Mean follow-up time was 2.35 ± (1.57) years. 7 (8.0%) of these patients began with long segment Barrett’s, 58 (66.7%) began with short segment disease, and 22 (25.3%) began with an ultrashort segment. Within this cohort, 74 (85.06%) had undergone postoperative biopsy. 7 out of 74 patients (9.46%) showed improvement in their intestinal metaplasia and 45/74 (60.81%) showed complete regression. Fisher’s exact test showed a significant decrease in Barrett’s length following MSA (p = 0.002). No patients progressed to dysplasia or neoplasia. There was a statistically significant decrease in the median Demeester score from 34.00 to 13.70 after surgery (p < .001).
Conclusion
MSA reduces esophageal acid exposure and can lead to reduction or resolution of Barrett’s esophagus. MSA is also effective at preventing progression of metaplasia to dysplasia or neoplasia. This effect remains consistent even after 2 years of follow-up.
Similar content being viewed by others
References
Yamasaki T, Hemond C, Eisa M, Ganocy S, Fass R (2018) The changing epidemiology of gastroesophageal reflux disease: are patients getting younger? J Neurogastroenterol Motil 24:559–569
Gerson LB, Shetler K, Triadafilopoulos G (2002) Prevalence of Barrett's esophagus in asymptomatic individuals. Gastroenterology 123:461–467
Ormsby AH, Kilgore SP, Goldblum JR, Richter JE, Rice TW, Gramlich TL (2000) The location and frequency of intestinal metaplasia at the esophagogastric junction in 223 consecutive autopsies: implications for patient treatment and preventive strategies in Barrett's esophagus. Mod Pathol 13:614–620
Patel A, Gyawali CP (2019) Screening for Barrett's esophagus: balancing clinical value and cost-effectiveness. J Neurogastroenterol Motil 25:181–188
Avidan B, Sonnenberg A, Schnell TG, Chejfec G, Metz A, Sontag SJ (2002) Hiatal hernia size, Barrett's length, and severity of acid reflux are all risk factors for esophageal adenocarcinoma. Am J Gastroenterol 97:1930–1936
Singh S, Garg SK, Singh PP, Iyer PG, El-Serag HB (2014) Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis. Gut 63:1229–1237
Hu Q, Sun TT, Hong J, Fang JY, Xiong H, Meltzer SJ (2017) Proton pump inhibitors do not reduce the risk of esophageal adenocarcinoma in patients with Barrett's esophagus: a systematic review and meta-analysis. PLoS ONE 12:e0169691
Simonka Z, Paszt A, Abraham S, Pieler J, Tajti J, Tiszlavicz L, Nemeth I, Izbeki F, Rosztoczy A, Wittmann T, Rarosi F, Lazar G (2012) The effects of laparoscopic Nissen fundoplication on Barrett's esophagus: long-term results. Scand J Gastroenterol 47:13–21
O'Riordan JM, Byrne PJ, Ravi N, Keeling PW, Reynolds JV (2004) Long-term clinical and pathologic response of Barrett's esophagus after antireflux surgery. Am J Surg 188:27–33
Hatlebakk JG, Zerbib F, Bruley des Varannes S, Attwood SE, Ell C, Fiocca R, Galmiche JP, Eklund S, Langstrom G, Lind T, Lundell LR, (2016) Gastroesophageal acid reflux control 5 years after antireflux surgery, compared with long-term esomeprazole therapy. Clin Gastroenterol Hepatol 14:678–685.e673
Oelschlager BK, Barreca M, Chang L, Oleynikov D, Pellegrini CA (2003) Clinical and pathologic response of Barrett's esophagus to laparoscopic antireflux surgery. Ann Surg 238:458–464
Knight BC, Devitt PG, Watson DI, Smith LT, Jamieson GG, Thompson SK (2017) Long-term efficacy of laparoscopic antireflux surgery on regression of Barrett's esophagus using bravo wireless ph monitoring: a prospective clinical cohort study. Ann Surg 266:1000–1005
Varban OA, McCoy TP, Westcott C (2011) A comparison of pre-operative comorbidities and post-operative outcomes among patients undergoing laparoscopic nissen fundoplication at high- and low-volume centers. Journal of Gastrointestinal Surgery 15:1121–1127
Bonavina L, Saino GI, Bona D, Lipham J, Ganz RA, Dunn D, Demeester T (2008) Magnetic augmentation of the lower esophageal sphincter: results of a feasibility clinical trial. J Gastrointestinal Surg 12:2133–2140
Reynolds JL, Zehetner J, Wu P, Shah S, Bildzukewicz N, Lipham JC (2015) Laparoscopic magnetic sphincter augmentation vs laparoscopic nissen fundoplication: a matched-pair analysis of 100 patients. J Am Coll Surg 221:123–128
Bell R, Lipham J, Louie B, Williams V, Luketich J, Hill M, Richards W, Dunst C, Lister D, McDowell-Jacobs L, Reardon P, Woods K, Gould J, Buckley FP, Kothari S, Khaitan L, Smith CD, Park A, Smith C, Jacobsen G, Abbas G, Katz P (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 89:14–22.e11
Lipham JC, Taiganides PA, Louie BE, Ganz RA, Demeester TR (2015) Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease. Dis Esophagus 28:305–311
Alicuben ET, Tatum JM, Bildzukewicz N, Samakar K, Samaan JS, Silverstein EN, Sandhu K, Houghton CC, Lipham JC (2019) Regression of intestinal metaplasia following magnetic sphincter augmentation device placement. Surg Endosc 33:576–579
Pohl H, Pech O, Arash H, Stolte M, Manner H, May A, Kraywinkel K, Sonnenberg A, Ell C (2016) Length of Barrett's oesophagus and cancer risk: implications from a large sample of patients with early oesophageal adenocarcinoma. Gut 65:196–201
Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 20:130–134
Rameez MH, Mayberry JF (2015) Epidemiology and risk factors for Barrett's oesophagus. Br J Hosp Med (Lond) 76:138–141
Team RC (2019) R: A language and environment for statistical computing., R Foundation for Statistical Computing, Vienna, Austria
Team R (2019) RStudio: integrated development for R. RStudio Inc, Boston, MA
Gurski RR, Peters JH, Hagen JA, DeMeester SR, Bremner CG, Chandrasoma PT, DeMeester TR (2003) Barrett's esophagus can and does regress after antireflux surgery: a study of prevalence and predictive features. J Am Coll Surg 196:706–712
Galmiche JP, Hatlebakk J, Attwood S, Ell C, Fiocca R, Eklund S, Langstrom G, Lind T, Lundell L (2011) Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. JAMA 305:1969–1977
DeMeester SR, Campos GM, DeMeester TR, Bremner CG, Hagen JA, Peters JH, Crookes PF (1998) The impact of an antireflux procedure on intestinal metaplasia of the cardia. Ann Surg 228:547–556
Leodolter A, Nocon M, Vieth M, Lind T, Jaspersen D, Richter K, Willich S, Stolte M, Malfertheiner P, Labenz J (2012) Progression of specialized intestinal metaplasia at the cardia to macroscopically evident Barrett's esophagus: an entity of concern in the ProGERD study. Scand J Gastroenterol 47:1429–1435
Sheu EG, Nau P, Nath B, Kuo B, Rattner DW (2015) A comparative trial of laparoscopic magnetic sphincter augmentation and Nissen fundoplication. Surg Endosc 29:505–509
Skubleny D, Switzer NJ, Dang J, Gill RS, Shi X, de Gara C, Birch DW, Wong C, Hutter MM, Karmali S (2017) LINX((R)) magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc 31:3078–3084
Louie BE, Farivar AS, Shultz D, Brennan C, Vallières E, Aye RW (2014) Short-term outcomes using magnetic sphincter augmentation versus nissen fundoplication for medically resistant gastroesophageal reflux disease. Annals Thoracic Surg 98:498–505
Cook MB, Wild CP, Forman D (2005) A systematic review and meta-analysis of the sex ratio for Barrett's esophagus, erosive reflux disease, and nonerosive reflux disease. Am J Epidemiol 162:1050–1061
O'Connell K, Velanovich V (2011) Effects of Nissen fundoplication on endoscopic endoluminal radiofrequency ablation of Barrett's esophagus. Surg Endosc 25:830–834
Funding
None received for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Lipham and Bildzukewicz are consultants for Ethicon which manufactures the LINX® device. Colin Dunn, Justin Henning, Paul Won, Caitlin Houghton and Jason Sterris have no conflict of interest or financial ties 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
About this article
Cite this article
Dunn, C.P., Henning, J.C., Sterris, J.A. et al. Regression of Barrett’s esophagus after magnetic sphincter augmentation: intermediate-term results. Surg Endosc 35, 5804–5809 (2021). https://doi.org/10.1007/s00464-020-08074-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-020-08074-6