Catherine Tsai, Ulf Kessler, Rudolf Steffen, Joerg Zehetner. Clinic Beau-Site
Background: Gastroesophageal reflux disease (GERD) is the most prevalent gastrointestinal disorder of the esophagus in the Western population. The magnetic lower esophageal sphincter augmentation (MSA) device is a novel treatment technique with promising results. As it becomes an increasingly common surgical option, understanding the temporary early side effects becomes important. Dysphagia is the most common temporary side effect after MSA, occurring in up to 83% of patients. While most cases self-resolve by three months, some cases persist and require further intervention. The aim of this study was to evaluate predictors of persistent post-operative dysphagia leading to intervention, as well as its impact on quality of life.
Methods: From August 2015 to September 2018 we reviewed the electronic medical records of all patients with GERD receiving a laparoscopic MSA (LINX reflux management system, Torax Medical) with posterior cruroplasty (PC). Demographic details, procedure details and outcome variables were recorded. Pre- and post-operative GERD-HRQL scores were obtained to assess symptom response. Patients with post-operative dysphagia requiring balloon dilation were identified, and variables were analyzed to asses for risk factors.
Results: There were 118 patients (M=59, F=59) with GERD treated with MSA-PC. Mean age was 50 years (R18-80) and mean duration of symptoms was 10.4 years (R1-40). One patient was converted to a Nissen fundoplication for persistent GERD. Based on GERD-HRQL scores (n=73 responses), 100% of patients had improved symptoms after MSA-PC. Post-operative dysphagia was present in 80 patients (67.8%). Of them, 20 (16.9%) required balloon dilation for persistent dysphagia. Patients received a median of 1 dilation at a mean of 5.6 months (R1-13) after MSA-PC. The MSA device was explanted in two patients, while dysphagia resolved in 15 patients. Two patients have persistent symptoms and the remaining patient has insufficient follow-up. Compared to patients who did not require dilation, dilated patients were more likely to have atypical GERD symptoms pre-operatively. However, 92.3% of non-explanted patients requiring dilation reported an improved quality of life.
Conclusion: Post-operative dysphagia after MSA-PC is a common temporary side effect and most commonly seen in patients with atypical GERD symptoms pre-operatively. Most cases of persistent dysphagia can be treated with a single balloon dilation. Despite requiring a dilation, the majority of patients still report an improved quality of life.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94947
Program Number: P485
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster