Daniel Skubleny, MD1, Noah J Switzer, MD1, Jerry Dang, MD1, Richdeep S Gill, MD, PhD, FRCSC2, Xinzhe Shi, MPH3, Christopher de Gara, MD, FRCSC1, Daniel W Birch, MD, FRCSC1, Clarence Wong, MD, FRCPC4, Matthew M Hutter, MD, MPH, FACS5, Shahzeer Karmali, MD, MPH, FRCSC1. 1Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada., 2Department of Surgery, Faculty of Medicine and Dentistry, University of Calgary, Calgary, Canada, 3Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Canada., 4Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada, 5Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
INTRODUCTION: The LINX® magnetic sphincter augmentation system (MSA) is a novel surgical technique with short-term evidence demonstrating efficacy in the treatment of medically refractory or chronic gastroesophageal reflux disease (GERD). Currently, the laparoscopic Nissen fundoplication (LNF) is the gold standard surgical treatment for GERD. Our aim was to systematically review the literature and perform a meta-analysis comparing MSA to LNF.
METHODS AND PROCEDURES: A search of MEDLINE, EMBASE, SCOPUS, Web of Science and the Cochrane Library using search terms “Gastroesophageal reflux or heartburn” and “LINX or endoluminal or magnetic” and “fundoplication or Nissen” was completed. All human, English language randomized controlled trials, non-randomized comparison studies, and case series were evaluated. 547 titles were identified through primary search and 197 titles or abstracts were screened after removing duplicates. Articles were selected by two independent reviewers based on the following inclusion criteria: (1) studies directly compared MSA with LNF; (2) studies included at least one primary outcome; and (3) enrolled at least 5 patients. Primary outcomes comprised ability to belch, ability for emesis, discontinuation of proton pump inhibitors, need for endoscopic dilation, procedural satisfaction, presence of gas/bloat and dysphagia. The quality of all included studies was assessed using the Methodological Index for Non-Randomized Studies. Meta-analysis was performed on primary outcome data.
RESULTS: Five primary studies identified a total of 854 patients, of which 355 and 499 underwent LNF and MSA, respectively. Mean duration of follow-up ranged from 7-16 months for LNF and 6-12 months for MSA. Loss to follow-up was 9.0% for LNF and MSA groups. MSA was statistically superior to Nissen in preserving patients ability to belch (95.2 vs 65.9%, p<0.00001) and ability for emesis (93.5 vs 49.5%, p<0.00001). There was no significant difference between MSA and Nissen in postoperative dysphagia (33.5 vs 41.2%, p=0.23), gas/bloating (24.9 vs 47.9%, p=0.15), need for endoscopic balloon dilation (18.1 vs 5.5%, p=0.11), proton pump inhibitor elimination (82.6 vs 84.6%, p=0.87) and satisfaction with procedure (90.7 vs 87.5%, p=0.11). Operative time for MSA was shorter at 61.9 minutes versus 81.8 minutes for LNF.
CONCLUSION: Magnetic sphincter augmentation appears to be an effective treatment for GERD with short-term outcomes comparable to Nissen fundoplication. MSA has a favorable side effect profile for the majority of morbidities associated with GERD surgery. However, long-term comparative outcome data past one year are needed in order to strengthen this conclusion.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79174
Program Number: P373
Presentation Session: Poster (Non CME)
Presentation Type: Poster
