Shahin Ayazi, MD, Ping Zheng, MD, Kirsten Newhams, MD, Fahim Habib, MD, Jonathan Levy, MD, Tameka Scott, DO, Kristy Chovanec, BS, Philip Jackson, BS, Yoshihiro Komatsu, MD, Toshitaka Hoppo, MD, Ali H Zaidi, MD, Blair A Jobe, MD. The Esophageal and Lung Institute, Allegheny Health Network
Introduction: The performance and durability of the various types of fundoplication is variable when stratified by disease severity. For example, partial fundoplication has been demonstrated to be an inadequate surgical treatment in patients with a very high DeMeester score (DS). To date, magnetic sphincter augmentation (MSA) has not been evaluated in this context and the majority of severe disease patients are referred for Nissen fundoplication. We hypothesize that MSA is an effective treatment in patients with severe reflux.
Methods and procedures: Baseline clinical and objective data were prospectively collected in patients who underwent MSA between June 2013 and July 2017. Outcomes were assessed using disease-specific questionnaires, upper endoscopy, pH monitoring, PPI use, and need for device removal. Based on previous studies, a DS≥50 was used as a cutoff to define severe disease. The study population was divided using this cutoff and outcomes were compared with those with less severe disease (DS<50).
Results: A total of 334 patients underwent MSA. The mean (SD) age was 52.7 (14.1) and 60% were female. There was no difference between groups in regard to age, BMI or duration of follow up (p>0.05). Patients with severe reflux had a higher mean preoperative DS compared to those with less severe disease [78.2 (11.1) vs. 22.8 (1.3), (p<0.0001)]. Patients with severe disease had a higher preoperative prevalence and severity grade of esophagitis [prevalence: 67% vs. 44%, p =0.0016, and combined LA grade C and D: 18% vs. 7%, p=0.0076)].
At a mean postoperative follow up of 13.6 (10.4) months, there was no difference between the GERD-HRQL total score in patients with severe disease compared to those with less severe disease [10.8 (12.9) vs. 9.8 (10.9), p=0.53]. This was also true for GERD-HRQL heartburn score [3.2 (6.0) vs. 3.2 (5.3), p=0.98] and RSI total score [8.1 (8.7) vs. 9.4 (8.8), p=0.32]. Postoperative DS was not different between groups [17.3 (23.0) vs. 14.1 (33.9), p=0.71], and there was no difference in the prevalence or grade of esophagitis [4 (20.0%) vs. 17 (15.0%), p=0.52], or PPI use [6 (11.5%) vs. 19 (8.2%), p=0.42]. There were similar rates of postoperative dysphagia (10% vs. 14%, p= 0.42) and need for device removal (3% vs. 5%, p= 0.63).
Conclusion: MSA is an effective treatment in patients with severe reflux disease and provides the same degree of clinical and objective improvement across the spectrum of disease severity.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94213
Program Number: P507
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster