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Efficacy of Magnetic Sphincter Augmentation Across the Spectrum of GERD Disease Severity

Katrin Schwameis, , Ping Zheng, Andrew D. Grubic, Madison Salvitti, Toshitaka Hoppo, Blair A. Jobe
Journal of the American College of Surgeons , Volume 232, pp 288-297; doi:10.1016/j.jamcollsurg.2020.11.012

Abstract: Background The performance and durability of various types of fundoplication are variable when stratified by disease severity. To date, magnetic sphincter augmentation (MSA) has not been evaluated in this context. We designed this study to determine the efficacy of MSA in the treatment of severe GERD. Study design Guided by previous studies, a DeMeester score (DMS) ≥ 50 was used as a cutoff point to define severe reflux disease. Subjects were divided into 2 groups using this cutoff, and outcomes of severe cases were compared with those with less severe disease (DMS < 50). Results A total of 334 patients underwent MSA. Patients with severe disease had a higher mean preoperative DMS compared with those with mild to moderate GERD (79.2 [53.2] vs 22.8 [13.7], p < 0.0001). At a mean postoperative follow-up of 13.6 (10.4) months, there was no difference between the mean GERD Health-Related Quality of Life (HRQL) total scores in patients with severe disease compared with those with less severe GERD (8.8 [10] vs 9.2 [10.8], p = 0.9204). Postoperative mean DMS was not different between groups (17.3[23.0] vs 14.1[33.9], p = 0.71), and there was no difference in the prevalence of esophagitis (p = 0.52). Patients with severe disease were less likely to be free from use of proton pump inhibitors after surgery (85% vs 93.1%, p = 0.041). There were similar rates of postoperative dysphagia (10% vs 14%, p = 0.42) and need for device removal (3% vs 5%, p = 0.7463). Conclusions MSA is an effective treatment in patients with severe GERD and leads to significant clinical improvement across the spectrum of disease severity, with few objective outcomes being superior in patients with mild-to-moderate reflux disease.
Keywords: BE; Barrett’s esophagus; DM; DeMeester score; HRQL; health-related quality of life; LES; lower esophageal sphincter; MSA; magnetic sphincter augmentation; PPI; proton pump inhibitor; RSI; reflux symptom index

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