Multi-institutional outcomes using magnetic sphincter augmentation versus Nissen fundoplication for chronic gastroesophageal reflux disease
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Magnetic sphincter augmentation (MSA) has emerged as an alternative surgical treatment of gastroesophageal reflux disease (GERD). The safety and efficacy of MSA has been previously demonstrated, although adequate comparison to Nissen fundoplication (NF) is lacking, and required to validate the role of MSA in GERD management.
A multi-institutional retrospective cohort study of patients with GERD undergoing either MSA or NF. Comparisons were made at 1 year for the overall group and for a propensity-matched group.
A total of 415 patients (201 MSA and 214 NF) underwent surgery. The groups were similar in age, gender, and GERD-HRQL scores but significantly different in preoperative obesity (32 vs. 40 %), dysphagia (27 vs. 39 %), DeMeester scores (34 vs. 39), presence of microscopic Barrett’s (18 vs. 31 %) and hiatal hernia (55 vs. 69 %). At a minimum of 1-year follow-up, 354 patients (169 MSA and 185 NF) had significant improvement in GERD-HRQL scores (pre to post: 21–3 and 19–4). MSA patients had greater ability to belch (96 vs. 69 %) and vomit (95 vs. 43 %) with less gas bloat (47 vs. 59 %). Propensity-matched cases showed similar GERD-HRQL scores and the differences in ability to belch or vomit, and gas bloat persisted in favor of MSA. Mild dysphagia was higher for MSA (44 vs. 32 %). Resumption of daily PPIs was higher for MSA (24 vs. 12, p = 0.02) with similar patient-reported satisfaction rates.
MSA for uncomplicated GERD achieves similar improvements in quality of life and symptomatic relief, with fewer side effects, but lower PPI elimination rates when compared to propensity-matched NF cases. In appropriate candidates, MSA is a valid alternative surgical treatment for GERD management.
KeywordsGastroesophageal reflux disease Anti-reflux surgery Multi-institutional Nissen fundoplication Outcomes
Dr. Heather Warren’s Advanced Gastrointestinal Surgery Fellowship at Swedish Medical Center was supported in part by the Ryan Hill Foundation.
Compliance with ethical standards
Drs. Lipham, Taiganides and Louie have received consulting fees from Torax Medical. Drs. Warren, Reynolds, Zehetner, Bildzukewicz, Aye, and Farivar, and Ms. Mickley have no conflicts of interest or financial ties to disclose.
- 2.Toghanian S, Johnson DA, Stalhammar NO, Zerbib R (2011) Burden of gastroesophageal reflux disease in patients with persistent and intense symptoms despite proton pump inhibitor therapy; a post hoc analysis of the 2007 National Health and Wellness Survey. Clin Drug Investig 31:703–715CrossRefPubMedGoogle Scholar
- 7.Lundell L, Miettinen P, Myrvold HE, Hatlebakk JG, Wallin L, Engstrom C, Julkunen R, Montgomery M, Malm A, Lind T, Walan A, Nordic GERD Study Group (2009) Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis. Clin Gastroenterol Hepatol 7:1292–1298CrossRefPubMedGoogle Scholar
- 17.Wileman SM, McCann S, Grant AM, Krukowski ZH (2010) Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Database Syst Rev 13:332–341Google Scholar
- 19.Peters JH, DeMeester TR, Crookes P, Oberg S, Vos Shoop M, Hagen JA, Bremner CG (1998) The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication. A prospective evaluation of 100 patients with typical symptoms. Ann Surg 228(1):40–50CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Ganz RA, Peters JH, Horgan S, Bermelman WA, Dunst CM, Edmondowicz SA, Lipham JC, Lukitich JD, Melvin WS, Oelschlager BK, Schlack-Haerere SC, Smith CD, Smith CC, Dunn D, Taiganides PA (2013) Esophageal sphincter device for gastroesophageal reflux disease. N Engl J Med 368:719–727CrossRefPubMedGoogle Scholar
- 33.Bonavina L, DeMeester T, Fockens P, Dunn D, Saino G, Bona D, Lipham J, Bemelman W, Ganz R (2010) Laparoscopic sphincter augmentation device eliminates reflux symptoms and normalizes esophageal acid exposure. One and 2 year results of a feasibility trail. Ann Surg 252(5):857–862CrossRefPubMedGoogle Scholar