• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES Top 21 MIS Procedures
    • SAGES Pearls
    • SAGES Flexible Endoscopy 101
    • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Factors Influencing the Outcome of Magnetic Sphincter Augmentation for Chronic Gerd

Heather F Warren, MD1, Lisa M Brown, MD2, Matias Mihura, MD3, Alexander S Farivar, MD3, Ralph W Aye, MD3, Brian E Louie, MD3. 1Dignity Health Medical Group, 2UC Davis Medical Center, 3Swedish Cancer Institute and Medical Center

OBJECTIVES: Magnetic sphincter augmentation (MSA) is a surgical treatment option for patients with GERD. The criteria used to select patients were based on limited data and with the goal of augmenting a relatively normal sphincter in patients with early GERD. In most patients, MSA results in substantial improvement in quality of life, freedom from PPIs and a low rate of esophagitis. However, 15-24% of patients resume PPIs, 11-12% have esophagitis and up to 3-4% will undergo device removal. We sought to identify factors predicting favorable outcomes after MSA placement with the aim of refining selection criteria.

METHODS: We retrospectively analyzed clinical, endoscopic, manometric, pH data and intra-operative factors from two databases: Pivotal Trial (N=100) and our prospectively maintained esophageal database (N=98). We defined apriori outcomes as excellent (GERD-HRQL<5, no PPI, no esophagitis); good (GERD-HRQL 6-15, no PPI, grade A esophagitis); Fair (GERD-HRQL 16 to 25, PPI use, grade B esophagitis); and, poor (GERD-HRQL>25, PPI use, grade C or D esophagitis). Univariate and multivariate analyses were done to predict which patients had either an excellent or good outcome.

RESULTS: A total of 198 patients underwent MSA with median age 52 years, 104 (53%) male and median BMI=27 (IQR=25-30).

At baseline, 186 (94%) patients experienced typical symptoms, 138 (70%) also reported atypical symptoms. PPI use led to complete relief in 83 (42%) and partial relief in 85 (43%). DeMeester score was 36.2 (IQR 26.8-51.7) with a structurally intact sphincter in 88 (44%). Esophagitis of any grade occurred in 88 (36%).

Operative time was 52 minutes (IQR:29-71). The hiatus was closed in 81 (41%) patients and a 14 bead device (N=89, 45%) was most common.

At 16 months after MSA, excellent outcomes were achieved in 81 (41%), good in 49 (25%), fair in 36 (18%) and poor in 8 (4.0%) (missing=24, 12%). Median DeMeester score was 14.7 (IQR=5.3-25.7), esophagitis detected in 31 (30%) and daily PPI use in 28 (14%).

At univariate analysis, excellent/good outcomes were adversely impacted by increasing BMI (OR=0.91, p=0.03), hiatal closure (OR=0.51, p=0.05), a structurally defective sphincter (OR=0.51, p=0.07) but positively impacted by longer LES length (OR=1.32, p=0.08). At multivariate analysis, BMI, defective LES and hiatal closure remained key factors.

CONCLUSIONS: Magnetic sphincter augmentation results in excellent/good outcomes in the majority of patients. Patients with a higher BMI and a structurally defective sphincter along with hiatal closure during implantation are less likely to have a favorable outcome after MSA.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 79946

Program Number: S141

Presentation Session: Plenary 2

Presentation Type: Podium

35

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube
  • Instagram
  • TikTok

Important Links

SAGES 2024 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons