Abstract
Background
Intestinal metaplasia represents an esophageal mucosal transformation due to uncontrolled gastroesophageal reflux disease. Fundoplication has been shown to lead to regression of disease. Magnetic sphincter augmentation is an alternative to fundoplication that effectively treats reflux disease. Initially, patients with intestinal metaplasia were not considered candidates for device placement, so outcomes in these patients are unknown.
Methods
A retrospective review of all patients who underwent magnetic sphincter augmentation device placement between 2007 and 2017 was performed. All patients underwent pre-operative endoscopic evaluation and were categorized as having ultra-short segment (less than 1 cm), short-segment (1–3 cm), or long-segment (greater than or equal to 3 cm) disease. To be included in the study, pathologic examination demonstrating columnar mucosa with goblet cells was required.
Results
There were 86 patients with biopsy-proven non-dysplastic intestinal metaplasia. 35 patients had ultra-short segment, 37 patients had short-segment, and 14 patients had long-segment disease. At a median follow-up of 1.2 years, 67/86 (78%) patients completed endoscopic follow-up. 48/67 (71.6%) patients had regression of intestinal metaplasia. There was no progression to dysplasia or carcinoma. Patients with abnormal post-operative DeMeester scores were less likely to have regression of disease. Regression was more likely in the ultra-short segment (82.8%) and short-segment (73.3%) groups compared to the long-segment group (25.0%).
Conclusions
Magnetic sphincter augmentation is effective in achieving regression of intestinal metaplasia. Longer-term follow-up is needed to assess durability of effect and make meaningful comparisons to fundoplication.
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Nikolai Bildzukewicz and John C. Lipham—consultant for Torax Medical, Inc. Evan T. Alicuben, James M. Tatum, Kamran Samakar, Jamil S. Samaan, Einav N. Silverstein, Kulmeet Sandhu, and Caitlin C. Houghton have no conflict of interest or financial ties to disclose.
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Alicuben, E.T., Tatum, J.M., Bildzukewicz, N. et al. Regression of intestinal metaplasia following magnetic sphincter augmentation device placement. Surg Endosc 33, 576–579 (2019). https://doi.org/10.1007/s00464-018-6367-x
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DOI: https://doi.org/10.1007/s00464-018-6367-x