Magnetic Sphincter Augmentation and Postoperative Dysphagia: Characterization, Clinical Risk Factors, and Management

• DOI: 10.1007/s11605-019-04331-9
• Publication Date: 2019-08-06T20:28:31Z
• Authors: Shahin Ayazi; Ping Zheng; Ali H. Zaidi; Kristy Chovanec; Nobel Chowdhury; Madison Salvitti; Yoshihiro Komatsu; Ashten N. Omstead; Toshitaka Hoppo; Blair A. Jobe
• Keywords: Nissen fundoplication; High resolution manometry

Magnetic sphincter augmentation (MSA) results in less severe side effects compared with Nissen fundoplication, but dysphagia remains the most common effect reported by patients after MSA. This study aimed to characterize and review management of postoperative identify preoperative factors that predict persistent is a retrospective prospectively collected data who underwent MSA between 2013 2018. Preoperative objective evaluation included upper endoscopy, esophagram, high-resolution impedance manometry (HRIM), esophageal pH testing. Postoperative was defined as score > 3 for dysphagia-specific item within GERD-HRQL at minimum months following A timeline dilation rates constructed correlated evolution our patient practices modifications surgical technique. total 380 MSA, mean (SD) follow up 11.5 (8.7) months, 59 (15.5%) were experiencing dysphagia. Thirty-one percent required least one or chest pain overall response rate this procedure 67%, 7 (1.8%) device removal specifically Independent predictors based on logistic regression model (1) absence large hernia (OR 2.86 (95% CI 1.08–7.57, p = 0.035)); (2) presence 2.19 1.05–4.58, 0.037)); (3) having than 80% peristaltic contractions HRIM 2.50 1.09–5.73, 0.031)). Graded cutoffs distal contractile integral (DCI), wave amplitude, DeMeester score, sex, body mass index evaluated did not Frequent eating surgery, avoidance early dilation, increase size LINX selected decreased need dilation. In cohort we report 15.5% The therapy efficacy each subsequent reduces. Patients normal hiatal anatomy, significant dysphagia, smooth muscle portion esophagus should be counseled they have an increased risk