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Using Magnetic Sphincter Augmentation for Treatment of Extra-esophageal Symptoms

Steven G Leeds, MD, Marc Ward, MD, Brittany Buckmaster, PA, Estrellita Ontiveros, MS. Baylor University Medical Center at Dallas

Background: Gastric contents can reach beyond the esophagus into the larynx and pharynx causing an increasingly prevalent disease called laryngopharyngeal reflux (LPR). Magnetic sphincter augmentation (MSA) has been used as an alternative treatment for GERD with good success, but there is no data to support its use in LPR.

Methods: Forty-five patients with MSA implants for symptomatic relief with both GERD and LPR symptoms were examined. All patients experienced at least one typical GERD symptom as well as at least one extra-esophageal symptom. This was assessed using the GERD-HRQL which is 15 questions graded 1 to 5 on each question, and Reflux Symptom Index (RSI) which is 9 questions graded 1 to 5 on each question. Patients filled out questionnaires preoperatively, one month post-operatively (early follow up), and at 6 months to 1 year postoperatively (late follow up). The responses on the GERD-HRQL were clustered into questions inquiring about heartburn (6), dysphagia (2), and regurgitation (6).

Results: Of 45 patients, there were 39 available for preoperative scoring with a GERD-HRQL mean of 3 for heartburn, 2.6 for regurgitation, and total score of 39.3 At early follow up for 33 patients, 0.3 for heartburn, 1.3 for dysphagia, 0.3 for regurgitation, and total GERD-HRQL score of 6.3. At late follow up for 19 patients, 0.3 for heartburn, 1.1 for dysphagia, 0.2 for regurgitation, and total GERD-HRQL score of 5.2. The RSI questions were separated to evaluate each individual symptom.  This showed an obvious downtrend of all typical, as well as LPR symptoms, pre and postoperatively. The total RSI score for 41 patients was 22.5, at early follow up 7.6 in 26 patients, and late follow up of 8.8 in 20 patients. Subset analysis of hoarseness and cough were done for the questions on the RSI corresponding to each symptom. Preoperative mean scores of 21 patients reporting hoarseness was 3.5, and in late follow up was 0.9. Preoperative mean scores in 19 patients that reporting chronic cough was 3.1, and in late follow up was 1.0. Further subset analysis showed almost complete resolution of symptoms in patients following MSA implantation for a chief complaint of hoarseness and chronic cough.

Conclusion: Although MSA has historically been used to treat GERD, it appears to be an effective treatment for control of LPR symptoms.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87739

Program Number: P454

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

48

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