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Magnetic Interventions for Gastroesophageal Reflux

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Abstract

Gastroesophageal reflux with or without hiatal hernia is a very prevalent disease that affects up to 30% of the population in western countries. Magnetic sphincter augmentation (Linx ™) is an innovative laparoscopic procedure for gastroesophageal reflux disease that provides a more standardized surgical option for patients dissatisfied with medical therapy and for those with early-stage disease who would not usually be considered ideal candidates for fundoplication. The Linx is a mechanical device manufactured in different sizes and designed to augment the physiologic barrier to reflux by magnetic force. The device consists of a series of titanium beads containing a magnetic core and interlinked with independent titanium wires to form an expandable ring. Magnetic sphincter augmentation is highly effective in reducing typical reflux symptoms and use of proton-pump inhibitors, decreasing esophageal acid exposure, and improving patients’ quality of life. Safety issues such as device erosions or migrations have been rare and not associated with mortality. The device can be easily removed laparoscopically, if necessary, thereby preserving the option of fundoplication or other therapies in the future. Potential limitations of the Linx procedure are the untested efficacy in the presence of large hiatal hernia and Barrett’s esophagus and the contraindication to undergo scanning in >1.5 Tesla magnetic resonance systems.

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References

  1. Toghanian S, Johnson DA, Stalhammar NO, Zerbib F. Burden of gastro-oesophageal 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. 2011;31:703–15.

    Article  CAS  PubMed  Google Scholar 

  2. Kahrilas PJ, Howden CW, Hughes N. Response of regurgitation to proton pump inhibitor therapy in clinical trials of gastroesophageal reflux disease. Am J Gastroenterol. 2011;106:1419–25.

    Article  PubMed  Google Scholar 

  3. Heidelbaugh JJ, Kim AH, Chang R, et al. Overutilization of proton-pump inhibitors: what the clinician needs to know. Ther Adv Gastroenterol. 2012;5(4):219–32.

    Article  Google Scholar 

  4. McColl K, Gillen D. Evidence that proton-pump inhibitor therapy induces the symptoms it is used to treat. Gastroenterology. 2009;137:20–2.

    Article  PubMed  Google Scholar 

  5. Poulsen AH, Christensen S, McLaughlin JK, et al. Proton pump inhibitors and risk of gastric cancer: a population-based cohort study. Br J Cancer. 2009;100:1503–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Lord R, DeMeester S, Peters J, et al. Hiatal hernia, lower esophageal sphincter incompetence, and effectiveness of Nissen fundoplication in the spectrum of gastroesophageal reflux disease. J Gastrointest Surg. 2009;13:602–10.

    Article  PubMed  Google Scholar 

  7. Malfertheiner P, Nocon M, Vieth M, et al. Evolution of gastro-oesophageal reflux disease over 5 years under routine medical care – the ProGERD study. Aliment Pharmacol Ther. 2012;35:154–64.

    Article  CAS  PubMed  Google Scholar 

  8. Stefanidis D, Hope WW, Kohn GP, et al. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc. 2010;24:2647–69.

    Article  PubMed  Google Scholar 

  9. Kohn GP, Price RR, DeMeester SR, et al. Guidelines for the management of hiatal hernia. Surg Endosc. 2013;27:4409–28.

    Article  PubMed  Google Scholar 

  10. Fuchs KH, Babic B, Breithaupt W, et al. EAES recommendations for the management of gastroesophageal reflux disease. Surg Endosc. 2014;28:1753–73.

    Article  PubMed  Google Scholar 

  11. Galmiche JP, Hatlebakk J, Attwood S, et al. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. JAMA. 2011;305(19):1969–77.

    Article  CAS  PubMed  Google Scholar 

  12. Broeders JA, Mauritz FA, Ahmed Ali U, et al. Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg. 2010;97:1318–30.

    Article  CAS  PubMed  Google Scholar 

  13. Hakanson BS, Lundell L, Bylund A, Thorell A. Comparison of laparoscopic 270° posterior partial fundoplication vs total fundoplication for the treatment of gastroesophageal reflux disease. A randomized clinical trial. JAMA Surg. https://doi.org/10.1001/jamasurg.2019.0047.

  14. Niebisch S, Fleming FJ, Galey KM, et al. Perioperative risk of laparoscopic fundoplication: safer than previously reported – analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2009. J Am Coll Surg. 2012;215:61–9.

    Article  PubMed  Google Scholar 

  15. Richter JE, Dempsey DT. Laparoscopic antireflux surgery: key to success in the community setting. Am J Gastroenterol. 2008;103:289–91.

    Article  PubMed  Google Scholar 

  16. Khajanchee YS, O’Rourke R, Cassera MA, et al. Laparoscopic reintervention for failed antireflux surgery: subjective and objective outcomes in 176 consecutive patients. Arch Surg. 2007;142:785–91.

    Article  PubMed  Google Scholar 

  17. Finks JF, Wei Y, Birkmeyer JD. The rise and fall of antireflux surgery in the United States. Surg Endosc. 2006;20:1698–701.

    Article  PubMed  Google Scholar 

  18. Colavita PD, Belyansky I, Walters AL, et al. Nationwide inpatient sample: have antireflux procedures undergone regionalization? J Gastrointest Surg. 2013;17:6–13.

    Article  PubMed  Google Scholar 

  19. Khan F, Maradey-Romero C, Ganocy S, Frazier R, Fass R. Utilisation of surgical fundoplication for patients with gastro-oesophageal reflux disease in the USA has declined rapidly between 2009 and 2013. Aliment Pharmacol Ther. 2016;43:1124–31.

    Article  CAS  PubMed  Google Scholar 

  20. Labenz J, Chandrasoma PJ, Knapp LJ, DeMeester TR. Proposed approach to the challenging management of progressive gastroesophageal reflux disease. World J Gastrointest Endosc. 2018;10:175–83.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Pinto D, Plieschnegger W, Schneider NI, et al. Carditis: a relevant marker of gastroesophageal reflux disease. Data from a prospective central European multicenter study on histological and endoscopic diagnosis of esophagitis (histoGERD trial). Dis Esophagus. 2019;32(1). https://doi.org/10.1093/dote/doy073.

  22. Ganz R, Gostout C, Grudem J, et al. Use of a magnetic sphincter for the treatment of GERD: a feasibility study. Gastrointest Endosc. 2008;67:287–94.

    Article  PubMed  Google Scholar 

  23. Bonavina L, Saino G, Bona D, et al. Magnetic augmentation of the lower esophageal sphincter: results of a feasibility clinical trial. J Gastrointest Surg. 2008;12:2133–40.

    Article  PubMed  Google Scholar 

  24. Bonavina L, DeMeester TR, Fockens P, et al. Laparoscopic sphincter augmentation device eliminates reflux symptoms and normalizes esophageal acid exposure. Ann Surg. 2010;252:857–62.

    Article  PubMed  Google Scholar 

  25. Lipham JC, DeMeester TR, Ganz RA, et al. The Linx reflux management system: confirmed safety and efficacy now at 4 years. Surg Endosc. 2012;26:2944–9.

    Article  PubMed  Google Scholar 

  26. Saino G, Bonavina L, Lipham J, Dunn D, Ganz RA. Magnetic sphincter augmentation for gastroesophageal reflux at 5 years: final results of a pilot study show long-term acid reduction and symptom improvement. J Laparoendosc Adv Surg Tech A. 2015;25:787–92.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ganz RA, Peters JH, Horgan S, et al. Esophageal sphincter device for gastroesophageal reflux disease. N Engl J Med. 2013;368:719–27.

    Article  CAS  PubMed  Google Scholar 

  28. Bonavina L, Saino G, Bona D, et al. One hundred consecutive patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease: 6 years of clinical experience from a single center. J Am Coll Surg. 2013;217:577–85.

    Article  PubMed  Google Scholar 

  29. Smith CD, Devault KR, Buchanan M. Introduction of mechanical sphincter augmentation for gastroesophageal reflux disease into practice: early clinical outcomes and keys to successful adoption. J Am Coll Surg. 2014;218:776–81.

    Article  PubMed  Google Scholar 

  30. Louie BE, Farivar AS, Schultz D, et al. Short-term outcomes using magnetic sphincter augmentation versus Nissen fundoplication for medically resistant gastroesophageal reflux disease. Ann Thorac Surg. 2014;98:498–504.

    Article  PubMed  Google Scholar 

  31. Riegler M, Schoppman SF, Bonavina L, et al. Magnetic sphincter augmentation and fundoplication for GERD in clinical practice: one-year results of a multicenter, prospective observational study. Surg Endosc. 2015;29:1123–9.

    Article  PubMed  Google Scholar 

  32. Reynolds J, Zehetner J, Wu P, et al. Laparoscopic magnetic sphincter augmentation vs laparoscopic Nissen fundoplication; a matched-pair analysis of 100 patients. Ann Surg. 2015;221:123–8.

    Google Scholar 

  33. Aiolfi A, Asti E, Bernardi D, et al. Early results of magnetic sphincter augmentation versus fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis. Int J Surg. 2018;52:82–8.

    Article  PubMed  Google Scholar 

  34. Rona KA, Reynolds J, Schwameis K, et al. Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias. Surg Endosc. 2017;31(5):2096–102.

    Article  PubMed  Google Scholar 

  35. Kuckelman JP, Phillips CJ, Hardin MO, et al. Standard vs expanded indications for esophageal magnetic sphincter augmentation for reflux disease. JAMA Surg. 2017;152(9):890–1.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Buckley FP, Bell RCW, Freeman K, et al. Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation. Surg Endosc. 2018;32:1762–8.

    Article  PubMed  Google Scholar 

  37. Schwameis K, Nikolic M, Morales Castellano DG, et al. Crural closure improves outcomes of magnetic sphincter augmentation in GERD patients with hiatal hernia. Sci Rep. 2018;8:7319.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Tatum JM, Alicuben E, Bildzukewicz N, et al. Minimal versus obligatory dissection of the diaphragmatic hiatus during magnetic sphincter augmentation surgery. Surg Endosc. 2019;33:782–8.

    Article  PubMed  Google Scholar 

  39. Irribarra MM, Blitz S, Wilshire CL, et al. Does treatment of the hiatus influence the outcomes of magnetic sphincter augmentation for chronic GERD? J Gastrointest Surg. 2019;23:1104–12.

    Article  PubMed  Google Scholar 

  40. Alicuben ET, Tatum JM, Bildzukewicz N, et al. Regression of intestinal metaplasia following magnetic sphincter augmentation device placement. Surg Endosc. 2019;33:576–9.

    Article  PubMed  Google Scholar 

  41. Bonavina L, Fisichella PM, Gavini S, Lee YY, Tatum RP. Clinical course of gastroesophageal reflux disease and impact of treatment in symptomatic young patients. Ann N Y Acad Sci. 2020. https://doi.org/10.1111/nyas.14350.

  42. Ayazi S, Zheng P, Zaidi AH, et al. Clinical outcomes and predictors of favorable results after laparoscopic magnetic sphincter augmentation: single-institution experience with more than 500 patients. J Am Coll Surg. 2020. doi.org/10.1016. ISSN 1072-7515-20.

    Google Scholar 

  43. Lipham JC, Taiganides PA, Louie BE, et al. Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease. Dis Esophagus. 2015;28:305–11.

    Article  CAS  PubMed  Google Scholar 

  44. Ganz RA, Edmundowicz SA, Taiganides PA, et al. Long-term outcomes of patients receiving a magnetic sphincter augmentation device for gastroesophageal reflux. Clin Gastroenterol Hepatol. 2016;14:671–7.

    Article  PubMed  Google Scholar 

  45. Asti E, Siboni S, Lazzari V, et al. Removal of the magnetic sphincter device. Surgical technique and results of a single-center cohort study. Ann Surg. 2017;265:941–5.

    Article  PubMed  Google Scholar 

  46. Bonavina L, DeMeester TR, Ganz R. LINX TM reflux management system: magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease. Expert Rev Gastroenterol Hepatol. 2012;6(6):667–74.

    Article  CAS  PubMed  Google Scholar 

  47. Worrel SG, Greene CL, DeMeester TR. The state of surgical treatment of gastroesophageal reflux disease after five decades. J Am Coll Surg. 2014;219:819–30.

    Article  Google Scholar 

  48. Mihura M, Louie BE. Laparoscopic antireflux surgery: magnetic GEJ augmentation. In: Grams J, Perry K, Tavakkoli A, editors. The SAGES manual of foregut surgery. Cham: Springer; 2019. p. 171–92.

    Chapter  Google Scholar 

  49. Bonavina L, Boyle N, Schoppmann S. The role of magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease. Curr Opin Gastroenterol. 2021. https://doi.org/10.1097/mog.0000000000000748.

    Chapter  Google Scholar 

  50. Bell R, Lipham J, Louie BE, et al. Magnetic sphincter augmentation superior to proton pump inhibitors for regurgitation in a 1-year randomized trial. Clin Gastroenterol Hepatol. 2020;18(8):1736–1743.e2.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milano School of Medicine, IRCCS Policlinico San Donato, Milan, Italy

    Luigi Bonavina

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  1. Luigi Bonavina
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Correspondence to Luigi Bonavina .

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  1. Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada

    Michel Gagner

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Bonavina, L. (2021). Magnetic Interventions for Gastroesophageal Reflux. In: Gagner, M. (eds) Magnetic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-73947-8_4

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  • DOI: https://doi.org/10.1007/978-3-030-73947-8_4

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  • Print ISBN: 978-3-030-73946-1

  • Online ISBN: 978-3-030-73947-8

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