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Regression of Barrett’s esophagus after magnetic sphincter augmentation: intermediate-term results

  • 2020 SAGES Oral
  • Published:
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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.

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None received for this study.

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Correspondence to John C. Lipham.

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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.

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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

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  • DOI: https://doi.org/10.1007/s00464-020-08074-6

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