Colin P Dunn, MD, Jason Sterris, Adrian Dobrowolsky, MD, FACS, Nikolai Bilduzkewicz, MD, FACS, John C Lipham, MD, FACS. University of Southern California
Introduction: Untreated gastroesophageal reflux disease can lead to intestinal metaplasia and ultimately increase a patient’s risk for esophageal adenocarcinoma. Magnetic sphincter augmentation (MSA) is a safe, efficacious modality for the treatment of gastroesophageal reflux disease. The short-term follow-up for patients having undergone MSA has shown regression of intestinal metaplasia. Further investigation is required to evaluate the long-term effect of this treatment.
Methods: A retrospective review was conducted for patients who underwent MSA between 2012 and 2017 at our institution. As a part of their preoperative evaluation, patients underwent esophagogastroduodenoscopy, pH testing, a videoesophagram, and pathologic examination of the distal esophagus and gastroesophageal junction. Study inclusion criteria required biopsy-proven intestinal metaplasia. Patients were stratified by intestinal metaplasia segment length observed during esophagogastroduodenoscopy. Improvement was defined as a change from long-segment to short-segment Barrett’s or short-segment Barrett’s to no evidence of Barrett’s esophagus.
Results: There were 91 patients identified for study inclusion. Fifty-eight patients were male. The mean body mass index was 27.0. The mean age was 58.4. Mean follow-up time was 2.6 years. Of those patients, 57/91 (56%) showed improvement in their intestinal metaplasia, with 28 (31%) showing complete regression. Only one of these patients began with long-segment Barrett’s; the rest were short-segment. Pearson’s chi-square analysis Χ2 (1, N = 91) = 11.774, p < .05, showed a statistically significant difference in pre-operative and post-operative intestinal metaplasia, indicating improvement following magnetic sphincter augmentation. No patients progressed to dysplasia or neoplasia. The median postoperative DeMeester score was 12.75, compared with the median preoperative DeMeester score of 35.3. Wilcoxon signed rank test showed postoperative DeMeester scores were significantly lower than preoperative DeMeester scores (p < .0001).
Conclusion: Magnetic sphincter augmentation reduces esophageal acid exposure and demonstrates impressive efficacy in the reduction or resolution of intestinal metaplasia. MSA is also effective at preventing progression of metaplasia to dysplasia or neoplasia. This effect remains consistent even after long-term follow-up.
This abstract was accepted for Podium presentation at the 2020 SAGES Virtual Meeting in the Foregut topic. Its program number was: S011 and its Abstract ID was: 102663