Daniel Skubleny1, Noah J Switzer2, Jerry Dang1, Richdeep S Gill3, Xinzhe Shi4, Christopher de Gara1,4, Daniel W Birch1,4, Clarence Wong5, Matthew M Hutter6, Shahzeer Karmali1,4. 1. Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre, 840-112 Street, Edmonton, T6G 2B7, Canada. 2. Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre, 840-112 Street, Edmonton, T6G 2B7, Canada. nswitzer@ualberta.ca. 3. Department of Surgery, Faculty of Medicine and Dentistry, University of Calgary, Calgary, Canada. 4. Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Canada. 5. Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 6. Department of Surgery, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: The LINX® magnetic sphincter augmentation system (MSA) is a surgical technique with short-term evidence demonstrating efficacy in the treatment of medically refractory or chronic gastroesophageal reflux disease (GERD). Currently, the Nissen fundoplication is the gold-standard surgical treatment for GERD. We are the first to systematically review the literature and perform a meta-analysis comparing MSA to the Nissen fundoplication. METHODS: A comprehensive search of electronic databases (e.g., MEDLINE, EMBASE, SCOPUS, Web of Science and the Cochrane Library) using search terms "Gastroesophageal reflux or heartburn" and "LINX or endoluminal or magnetic" and "fundoplication or Nissen" was completed. All randomized controlled trials, non-randomized comparison study and case series with greater than 5 patients were included. Five hundred and forty-seven titles were identified through primary search, and 197 titles or abstracts were screened after removing duplicates. Meta-analysis was performed on postoperative quality of life outcomes, procedural efficacy and patient procedural satisfaction. RESULTS: Three primary studies identified a total of 688 patients, of whom 273 and 415 underwent Nissen fundoplication and MSA, respectively. MSA was statistically superior to LNF in preserving patient's ability to belch (95.2 vs 65.9%, p < 0.00001) and ability to emesis (93.5 vs 49.5%, p < 0.0001). There was no statistically significant difference between MSA and LNF in gas/bloating (26.7 vs 53.4%, p = 0.06), postoperative dysphagia (33.9 vs 47.1%, p = 0.43) and proton pump inhibitor (PPI) elimination (81.4 vs 81.5%, p = 0.68). CONCLUSION: Magnetic sphincter augmentation appears to be an effective treatment for GERD with short-term outcomes comparable to the more technically challenging and time-consuming Nissen fundoplication. Long-term comparative outcome data past 1 year are needed in order to further understand the efficacy of magnetic sphincter augmentation.
BACKGROUND: The LINX® magnetic sphincter augmentation system (MSA) is a surgical technique with short-term evidence demonstrating efficacy in the treatment of medically refractory or chronic gastroesophageal reflux disease (GERD). Currently, the Nissen fundoplication is the gold-standard surgical treatment for GERD. We are the first to systematically review the literature and perform a meta-analysis comparing MSA to the Nissen fundoplication. METHODS: A comprehensive search of electronic databases (e.g., MEDLINE, EMBASE, SCOPUS, Web of Science and the Cochrane Library) using search terms "Gastroesophageal reflux or heartburn" and "LINX or endoluminal or magnetic" and "fundoplication or Nissen" was completed. All randomized controlled trials, non-randomized comparison study and case series with greater than 5 patients were included. Five hundred and forty-seven titles were identified through primary search, and 197 titles or abstracts were screened after removing duplicates. Meta-analysis was performed on postoperative quality of life outcomes, procedural efficacy and patient procedural satisfaction. RESULTS: Three primary studies identified a total of 688 patients, of whom 273 and 415 underwent Nissen fundoplication and MSA, respectively. MSA was statistically superior to LNF in preserving patient's ability to belch (95.2 vs 65.9%, p < 0.00001) and ability to emesis (93.5 vs 49.5%, p < 0.0001). There was no statistically significant difference between MSA and LNF in gas/bloating (26.7 vs 53.4%, p = 0.06), postoperative dysphagia (33.9 vs 47.1%, p = 0.43) and proton pump inhibitor (PPI) elimination (81.4 vs 81.5%, p = 0.68). CONCLUSION: Magnetic sphincter augmentation appears to be an effective treatment for GERD with short-term outcomes comparable to the more technically challenging and time-consuming Nissen fundoplication. Long-term comparative outcome data past 1 year are needed in order to further understand the efficacy of magnetic sphincter augmentation.
Entities:
Keywords:
Fundoplication; GERD; Magnetic sphincter augmentation
Authors: Jessica L Reynolds; Joerg Zehetner; Phil Wu; Shawn Shah; Nikolai Bildzukewicz; John C Lipham Journal: J Am Coll Surg Date: 2015-03-05 Impact factor: 6.113
Authors: Donald O Castell; Peter J Kahrilas; Joel E Richter; Nimish B Vakil; David A Johnson; Seth Zuckerman; Wendy Skammer; Jeffrey G Levine Journal: Am J Gastroenterol Date: 2002-03 Impact factor: 10.864
Authors: Brian E Louie; Alexander S Farivar; Dale Shultz; Christina Brennan; Eric Vallières; Ralph W Aye Journal: Ann Thorac Surg Date: 2014-06-21 Impact factor: 4.330
Authors: Lars Lundell; Pekka Miettinen; Helge E Myrvold; Jan G Hatlebakk; Lene Wallin; Cecilia Engström; Risto Julkunen; Madeline Montgomery; Anders Malm; Tore Lind; Anders Walan Journal: Clin Gastroenterol Hepatol Date: 2009-05-31 Impact factor: 11.382
Authors: Heather F Warren; Jessica L Reynolds; John C Lipham; Joerg Zehetner; Nikolai A Bildzukewicz; Paul A Taiganides; Jody Mickley; Ralph W Aye; Alexander S Farivar; Brian E Louie Journal: Surg Endosc Date: 2015-11-05 Impact factor: 4.584
Authors: Heather F Warren; Lisa M Brown; Matias Mihura; Alexander S Farivar; Ralph W Aye; Brian E Louie Journal: Surg Endosc Date: 2017-06-29 Impact factor: 4.584
Authors: Philip O Katz; Kerry B Dunbar; Felice H Schnoll-Sussman; Katarina B Greer; Rena Yadlapati; Stuart Jon Spechler Journal: Am J Gastroenterol Date: 2022-01-01 Impact factor: 10.864