Heather F Warren1, Lisa M Brown2, Matias Mihura3, Alexander S Farivar3, Ralph W Aye3, Brian E Louie4. 1. Dignity Health, Mercy Medical Center, Redding, CA, USA. 2. Section of Thoracic Surgery, University of California Davis, Sacramento, CA, USA. 3. Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, 1101 Madison Street Suite 900, Seattle, WA, 98104, USA. 4. Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, 1101 Madison Street Suite 900, Seattle, WA, 98104, USA. Brian.Louie@swedish.org.
Abstract
OBJECTIVES: Magnetic sphincter augmentation (MSA) is a surgical treatment option for patients with gastroesophageal reflux disease (GERD). MSA consistently improves quality of life, maintains freedom from PPIs, and objectively controls GERD. However, up to 24% of patients did not achieve these outcomes. We sought to identify factors predicting outcomes after MSA placement with the aim of refining selection criteria. METHODS: We retrospectively analyzed clinical, endoscopic, manometric, pH data, and intraoperative factors from two databases: Pivotal Trial (N = 99) and our prospectively maintained esophageal database (N = 71). A priori outcomes were defined as excellent (GERD-HRQL <5, no PPI, no esophagitis), good (GERD-HRQL 6-15, no PPI, grade A esophagitis), fair (GERD-HRQL 16 to 25, PPI use, grade B esophagitis), and poor (GERD-HRQL >25, PPI use, grade C/D esophagitis). Univariable and multivariable logistic regression analyses were performed to determine predictors of achieving an excellent/good outcome. RESULTS: A total of 170 patients underwent MSA with a median age of 53 years, [43-60] and a median BMI of 27 (IQR = 24-30). At baseline, 93.5% of patients experienced typical symptoms and 69% atypical symptoms. Median DeMeester score was 37.9 (IQR 27.9-51.2) with a structurally intact sphincter in 47%. Esophagitis occurred in 43%. At 48 [19-60] months after MSA, excellent outcomes were achieved in 47%, good in 28%, fair in 22%, and poor in 3%. Median DeMeester score was 15.6 (IQR = 5.8-26.6), esophagitis in 17.6% and daily PPI use in 17%. At univariable analysis, excellent/good outcomes were negatively impacted by BMI, preoperative LES residual pressure, Hill grade, and hiatal hernia. At multivariable analysis, BMI >35 (OR = 0.05, 0.003-0.78, p = 0.03), structurally defective LES (OR = 0.37, 0.13-0.99, p = 0.05), and preoperative LES residual pressure (OR = 0.89, 0.80-0.98, p = 0.02) were independent negative predictors of excellent/good outcome. CONCLUSIONS: Magnetic sphincter augmentation results in excellent/good outcomes in most patients but a higher BMI, structurally defective sphincter, and elevated LES residual pressure may prevent this goal.
OBJECTIVES: Magnetic sphincter augmentation (MSA) is a surgical treatment option for patients with gastroesophageal reflux disease (GERD). MSA consistently improves quality of life, maintains freedom from PPIs, and objectively controls GERD. However, up to 24% of patients did not achieve these outcomes. We sought to identify factors predicting outcomes after MSA placement with the aim of refining selection criteria. METHODS: We retrospectively analyzed clinical, endoscopic, manometric, pH data, and intraoperative factors from two databases: Pivotal Trial (N = 99) and our prospectively maintained esophageal database (N = 71). A priori outcomes were defined as excellent (GERD-HRQL <5, no PPI, no esophagitis), good (GERD-HRQL 6-15, no PPI, grade A esophagitis), fair (GERD-HRQL 16 to 25, PPI use, grade B esophagitis), and poor (GERD-HRQL >25, PPI use, grade C/D esophagitis). Univariable and multivariable logistic regression analyses were performed to determine predictors of achieving an excellent/good outcome. RESULTS: A total of 170 patients underwent MSA with a median age of 53 years, [43-60] and a median BMI of 27 (IQR = 24-30). At baseline, 93.5% of patients experienced typical symptoms and 69% atypical symptoms. Median DeMeester score was 37.9 (IQR 27.9-51.2) with a structurally intact sphincter in 47%. Esophagitis occurred in 43%. At 48 [19-60] months after MSA, excellent outcomes were achieved in 47%, good in 28%, fair in 22%, and poor in 3%. Median DeMeester score was 15.6 (IQR = 5.8-26.6), esophagitis in 17.6% and daily PPI use in 17%. At univariable analysis, excellent/good outcomes were negatively impacted by BMI, preoperative LES residual pressure, Hill grade, and hiatal hernia. At multivariable analysis, BMI >35 (OR = 0.05, 0.003-0.78, p = 0.03), structurally defective LES (OR = 0.37, 0.13-0.99, p = 0.05), and preoperative LES residual pressure (OR = 0.89, 0.80-0.98, p = 0.02) were independent negative predictors of excellent/good outcome. CONCLUSIONS: Magnetic sphincter augmentation results in excellent/good outcomes in most patients but a higher BMI, structurally defective sphincter, and elevated LES residual pressure may prevent this goal.
Entities:
Keywords:
Esophagitis; Gastroesophageal reflux disease; LINX; Magnetic sphincter augmentation; Postoperative outcomes; Proton pump inhibitors; Quality of life
Authors: G M Campos; J H Peters; T R DeMeester; S Oberg; P F Crookes; S Tan; S R DeMeester; J A Hagen; C G Bremner Journal: J Gastrointest Surg Date: 1999 May-Jun Impact factor: 3.452
Authors: Daniel Skubleny; Noah J Switzer; Jerry Dang; Richdeep S Gill; Xinzhe Shi; Christopher de Gara; Daniel W Birch; Clarence Wong; Matthew M Hutter; Shahzeer Karmali Journal: Surg Endosc Date: 2016-12-15 Impact factor: 4.584
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: 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: 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: Brian E Louie; Seema Kapur; Maurice Blitz; Alexander S Farivar; Eric Vallières; Ralph W Aye Journal: J Gastrointest Surg Date: 2012-11-27 Impact factor: 3.452
Authors: Matías Mihura Irribarra; Sandra Blitz; Candice L Wilshire; Anee Sophia Jackson; Alexander S Farivar; Ralph W Aye; Christy M Dunst; Brian E Louie Journal: J Gastrointest Surg Date: 2019-03-15 Impact factor: 3.452
Authors: Reid Fletcher; Christy M Dunst; Walaa F Abdelmoaty; Evan T Alicuben; Ealaf Shemmeri; Brett Parker; Dolores Müller; Ahmed M Sharata; Kevin M Reavis; Daniel Davila Bradley; Nikolai A Bildzukewicz; Brian E Louie; John C Lipham; Steven R DeMeester Journal: Surg Endosc Date: 2020-07-15 Impact factor: 4.584