Abstract
Background
The magnetic sphincter augmentation device (MSA) provides effective relief of gastroesophageal reflux symptoms. Dysphagia after MSA implantation sometimes prompts endoscopic dilation. The manufacturer’s instructions are that it be performed 6 or more weeks after implantation under fluoroscopic guidance to not more than 15 mm keeping 3 or more beads closed. The purpose of this study was to assess adherence to these recommendations and explore the techniques used and outcomes after MSA dilation.
Methods and procedures
We conducted a multicenter retrospective review of patients undergoing dilation for dysphagia after MSA placement from 2012 to 2018.
Results
A total of 144 patients underwent 245 dilations. The median size of MSA placed was 14 beads (range 12–17) and the median time to dilation was 175 days. A second dilation was performed in 67 patients, 22 patients had a third dilation and 7 patients underwent 4 or more dilations. In total, 17 devices (11.8%) were eventually explanted. The majority of dilations were performed with a balloon dilator (81%). The median dilator size was 18 mm and 73.4% were done with a dilator larger than 15 mm. There was no association between dilator size and need for subsequent dilation. Fluoroscopy was used in 28% of cases. There were no perforations or device erosions related to dilation.
Discussion
There is no clinical credence to the manufacturer’s recommendation for the use of fluoroscopy and limitation to 15 mm when dilating a patient for dysphagia after MSA implantation. Use of a larger size dilator was not associated with perforation or device erosion, but also did not reduce the need for repeat dilation. Given this, we would recommend that the initial dilation for any size MSA device be done using a 15 mm through-the-scope balloon dilator. Dysphagia prompting dilation after MSA implantation is associated with nearly a 12% risk of device explantation.
Similar content being viewed by others
Reference
Reynolds JL, Zehetner J, Wu P, Shah S, Bildzukewicz N, Lipham JC (2015) Laparoscopic magnetic sphincter augmentation vs laparoscopic nissen fundoplication: a matched-pair analysis of 100 patients. J Am Coll Surg 221(1):123–128. https://doi.org/10.1016/j.jamcollsurg.2015.02.025
Broeders JA, Bredenoord AJ, Hazebroek EJ, Broeders IA, Gooszen HG, Smout AJ (2012) Reflux and belching after 270 degree versus 360 degree laparoscopic posterior fundoplication. Ann Surg 255(1):59–65
Louie BE, Farivar AS, Shultz D, Brennan C, Vallières E, Aye RW (2014) Short-term outcomes using magnetic sphincter augmentation versus nissen fundoplication for medically resistant gastroesophageal reflux disease. Ann Thorac Surg 98(2):498–505. https://doi.org/10.1016/j.athoracsur.2014.04.074
Bell R, Lipham J, Louie B et al (2019) Laparoscopic magnetic sphincter augmentation versus double-dose proton pump inhibitors for management of moderate-to-severe regurgitation in GERD: a randomized controlled trial. Gastrointest Endosc 89(1):14–22. https://doi.org/10.1016/j.gie.2018.07.007
Warren HF, Brown LM, Mihura M, Farivar AS, Aye RW, Louie BE (2018) Factors influencing the outcome of magnetic sphincter augmentation for chronic gastroesophageal reflux disease. Surg Endosc 32(1):405–412. https://doi.org/10.1007/s00464-017-5696-5
Buckley FP, Bell RCW, Freeman K, Doggett S, Heidrick R (2018) Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation. Surg Endosc 32(4):1762–1768. https://doi.org/10.1007/s00464-017-5859-4
Louie BE, Smith CD, Smith CC et al (2019) Objective evidence of reflux control after magnetic sphincter augmentation: one year results from a post approval study. Ann Surg 270(2):302–308
Ganz RA, Edmundowicz SA, Taiganides PA et al (2016) Long-term outcomes of patients receiving a magnetic sphincter augmentation device for gastroesophageal reflux. Clin Gastroenterol Hepatol 14(5):671–677. https://doi.org/10.1016/j.cgh.2015.05.028
Ayazi S, Zheng P, Zaidi AH et al (2020) Magnetic sphincter augmentation and postoperative dysphagia: characterization, clinical risk factors, and management. J Gastrointest Surg 24(1):39–49. https://doi.org/10.1007/s11605-019-04331-9
Ayazi S, Zheng P, Zaidi AH et al (2020) Clinical outcome and predictors of favorable result after laparoscopic magnetic sphincter augmentation: single institution experience with over 500 patients. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2020.01.026
Lipham JC, Taiganides PA, Louie BE, Ganz RA, DeMeester TR (2015) Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease. Dis Esophagus 28(4):305–311. https://doi.org/10.1111/dote.12199
Torax Medical. LINX reflux management system device dilation. Doc. No. 3788 Rev. 2.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Dunst and DeMeester are paid consultants for Bard. Drs. Lipham, Louie, and Bildzukewicz are paid consultants for Ethicon. Dr Müller receives research support from Restech. Drs. Fletcher, Abdelmoaty, Alicuben, Shemmeri, Parker, Sharata, Reavis, and Davila Bradley have no conflicts or financial interests to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Fletcher, R., Dunst, C.M., Abdelmoaty, W.F. et al. Safety and efficacy of magnetic sphincter augmentation dilation. Surg Endosc 35, 3861–3864 (2021). https://doi.org/10.1007/s00464-020-07799-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-020-07799-8