James M Tatum, MD, Evan Alicuben, MD, Nikolai Bildzukewicz, MD, Kulmeet Sandhu, MD, Kameran Samakar, MD, Caitlin Houghton, MD, John L Lipham, MD. Keck School Of Medicine Of The University Of Southern California
Introduction: Intestinal metaplasia (IM) is a known precursor to both dysplastic tissue changes and to carcinoma of the distal esophagus. We hypothesize that regression of intestinal metaplasia occurs after implantation of the magnetic sphincter augmentation device.
Patient and Methods: Between December 2012 and September 2016, 189 patients underwent MSA implant at a single medical center, follow up was through September 2017. Of these patients 96% (181/189) had preoperative endoscopically sampled distal esophageal tissue examined by a pathologist for IM. Patients with pre-operative IM and a post-operative repeat endoscopic tissue sample were examined for resolution of IM. Data were analyzed with SPSS (SPSS Inc.), Kaplan-Meier (K-M) analysis was used to account for varying time at risk.
Results: Of the 181 patients with pre-operative pathology, 24% (44/181) were diagnosed with IM. Of these 44 patients, 59% (26/44) had post-operative endoscopic repeat tissue sampling with pathological analysis performed at times ranging from 176 to 1166 days after MSA implant (mean 522 days, SD 314 days). Of the sample, 73% (19/26) of patients had resolution of IM on repeat endoscopically obtained distal esophageal biopsies. K-M analysis for persistence of IM at 1 and 3 years was 75% (Std. Error 8.8%) and 6% (Std. Error 5.8%), respectively. Pathology samples were not available for review beyond three years.
Conclusion: Magnetic sphincter augmentation device implantation, through effects of decreased acid exposure, may lead to regression of intestinal metaplasia of the distal esophagus. Further studies with more attention to protocolized endoscopic tissue sampling are needed to further elucidate this potentially important relationship.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88340
Program Number: S095
Presentation Session: Foregut/Gastric Session
Presentation Type: Podium
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