Abhishek D Parmar, MD, MS1, Howard Chang, MD2, Jonathan D Svahn, MD, FACS2. 1UCSF-East Bay Department of Surgery, 2Kaiser Permanente Oakland Medical center
INTRODUCTION: Implanting a magnetic lower esophageal sphincter augmentation device (Linx, Torax Medical) has become an increasingly common option in the surgical management of gastroesophageal reflux disease. As the enthusiasm for placing this device increases, experience in the management of device-related complications—including erosion—is necessary.
METHODS: We report a staged approach to Linx removal in a 64-year-old female with symptoms of odynophagia secondary to partial erosion of a Linx device into the esophagus.
RESULTS: The patient had a 12 bead Linx device placed in 2011 at an outside international facility. In late 2013, she began experiencing symptoms of odynophagia. An esophagogastroduodenoscopy at our institution in October 2015 demonstrated two metallic beads eroding through the distal esophageal lumen. An elective endoscopic removal of the two visible beads was performed. A postoperative esophagram confirmed that there was no resulting esophageal perforation. The patient noted mild improvement in her symptoms. After a twelve-week period to allow for complete healing, the remaining ten beads of the Linx device were explanted laparoscopically without complication. No further procedures were undertaken. At two months’ follow-up, the patient noted complete resolution of her symptoms.
CONCLUSION: Transmural erosion of the Linx device into the esophageal lumen is a rare occurrence, with only five such reported complications in the published literature. We present the first account of Linx explantation for esophageal erosion in the United States. We demonstrated that a staged laparo-endoscopic approach to Linx removal in these cases is feasible with minimal morbidity.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77295
Program Number: P408
Presentation Session: Poster (Non CME)
Presentation Type: Poster