Elizabeth Long, MD, Jemimah Chen, MS, William Richards, Chairman of Surgery. University of South Alabama
Objective: To demonstrate the importance of a complete and thorough work up of gastroesophageal reflux disease (GERD) and the success and effectiveness of a new anti-reflux procedure with magnetized sphincter augmentation (LINX reflux management system).
Background: GERD is a chronic digestive disorder affecting 20% of U.S. adults. Standard treatment has been lifestyle change, proton pump inhibitors, or alternative surgical management with a Nissen fundoplication.
Methods: 20 patients presented for treatment with medically refractory GERD. A complete work up included a gastroesophageal reflux disease – health related quality of life (GERD HRQL) questionnaire, endoscopy, esophageal manometry, 24 hour ambulatory pH study, and barium swallow. The GERD HRQL questionnaire consists of 10 questions assessing the severity of GERD symptoms on a scale of 0-5 with 0 being symptoms never experienced to 5 being the symptom is incapacitating and occurring daily despite medical treatment. The esophageal pH monitoring was done in a consecutive 24 hour period to record the esophageal pH. Endoscopy, barium swallow, and esophageal manometry assessed the mucosal surface and peristalsis of the esophagus. Post-operatively patients completed the GERD-HRQL and questions about satisfaction and PPI use at 3 months and 6 months
Results: Due to proper pre-operative work up 4 of the 20 patients were found to have contraindications to the new anti-reflux procedure with magnetized sphincter augmentation (LINX reflux management system). Two of these patients were found to have achalasia, one had scleroderma, and one had esophagogastric junction outflow obstruction status post a Nissen fundoplication. Pre-operatively, the mean GERD-HRQL total was 33 while on PPI therapy. All 8 patients (100%) were “dissatisfied” with their pre-operative condition while taking PPIs either daily or twice daily. Post-operatively, the mean GERD-HRQL total was 6. This was an 82% decrease in mean GERD-HRQL total. 7 out of 8 patients (87.5%) reported feeling “satisfied” and 1 reported feeling “neutral.” 7 out of 8 patients were completely off PPIs at follow up.
Conclusions: Proper pre-operative work up with GERD HRQL questionnaire, esophageal manometry, 24 hour ambulatory pH study, and barium swallow is imperative to assessing success with the LINX reflux management system. The LINX reflux management system increases patient satisfaction and quality of life and decreases PPI use at 3 months and 6 months. Long-term effects cannot be made at this time but the study will continue.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80068
Program Number: P381
Presentation Session: Poster (Non CME)
Presentation Type: Poster
