AUTHOR=Ferrari Davide , Siboni Stefano , Riva Carlo Galdino , Guerrazzi Guglielmo , Lovece Andrea , Bonavina Luigi 

TITLE=Magnetic Sphincter Augmentation Outcomes in Severe Gastroesophageal Reflux Disease

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.645592

DOI=10.3389/fmed.2021.645592

ISSN=2296-858X

ABSTRACT=<p><bold>Introduction:</bold> Outcomes of laparoscopic procedures for gastroesophageal reflux disease (GERD) are variable depending on surgical expertise and/or patient-related factors. Some procedures may be inadequate in patients with severe disease. Effectiveness of laparoscopic magnetic sphincter augmentation (MSA) has not been extensively tested in patients with severe disease.</p><p><bold>Methods:</bold> A prospectively collected database was analyzed to identify patients who underwent MSA at a single institution. Individuals who had previous esophago-gastric surgery were excluded. Severe GERD was defined as lower esophageal sphincter pressure &lt;5 mmHg, distal esophageal amplitude &lt;30 mmHg, Barrett's metaplasia, stricture or grade C-D esophagitis, and/or DeMeester score &gt;50. Clinical characteristics and outcomes of patients with severe GERD were compared with those of patients with mild to moderate GERD who served as control group.</p><p><bold>Results:</bold> Over the study period, a total of 336 patients met the inclusion criteria, and 102 (30.4%) had severe GERD. The median follow-up was 24 months (IQR = 75) in severe GERD patients and 32 months (IQR = 84) in those with non-severe GERD. Patients with severe GERD had a higher rate of dysphagia and higher GERD-HRQL scores. After the MSA procedure, symptoms, health-related quality of life scores, and proton-pump inhibitors consumption significantly decreased in both groups (<italic>p</italic> &lt; 0.05). No difference between groups was found in the prevalence of severe post-operative dysphagia, the need for endoscopic dilation or device removal, and the DeMeester score.</p><p><bold>Conclusion:</bold> Laparoscopic MSA is safe and effective in reducing symptoms, PPI use, and esophageal acid exposure also in patients with severe GERD.</p>