Abstract
Objectives: Magnetic sphincter augmentation (MSA) is a surgical treatment option for patients with gastroesophageal reflux disease (GERD). MSA consistently improves quality of life, maintains freedom from PPIs, and objectively controls GERD. However, up to 24% of patients did not achieve these outcomes. We sought to identify factors predicting outcomes after MSA placement with the aim of refining selection criteria. Methods: We retrospectively analyzed clinical, endoscopic, manometric, pH data, and intraoperative factors from two databases: Pivotal Trial (N = 99) and our prospectively maintained esophageal database (N = 71). A priori outcomes were defined as excellent (GERD-HRQL <5, no PPI, no esophagitis), good (GERD-HRQL 6–15, no PPI, grade A esophagitis), fair (GERD-HRQL 16 to 25, PPI use, grade B esophagitis), and poor (GERD-HRQL >25, PPI use, grade C/D esophagitis). Univariable and multivariable logistic regression analyses were performed to determine predictors of achieving an excellent/good outcome. Results: A total of 170 patients underwent MSA with a median age of 53 years, [43–60] and a median BMI of 27 (IQR = 24–30). At baseline, 93.5% of patients experienced typical symptoms and 69% atypical symptoms. Median DeMeester score was 37.9 (IQR 27.9–51.2) with a structurally intact sphincter in 47%. Esophagitis occurred in 43%. At 48 [19–60] months after MSA, excellent outcomes were achieved in 47%, good in 28%, fair in 22%, and poor in 3%. Median DeMeester score was 15.6 (IQR = 5.8–26.6), esophagitis in 17.6% and daily PPI use in 17%. At univariable analysis, excellent/good outcomes were negatively impacted by BMI, preoperative LES residual pressure, Hill grade, and hiatal hernia. At multivariable analysis, BMI >35 (OR = 0.05, 0.003–0.78, p = 0.03), structurally defective LES (OR = 0.37, 0.13–0.99, p = 0.05), and preoperative LES residual pressure (OR = 0.89, 0.80–0.98, p = 0.02) were independent negative predictors of excellent/good outcome. Conclusions: Magnetic sphincter augmentation results in excellent/good outcomes in most patients but a higher BMI, structurally defective sphincter, and elevated LES residual pressure may prevent this goal.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1-8 |
| Number of pages | 8 |
| Journal | Surgical Endoscopy and Other Interventional Techniques |
| DOIs | |
| State | Accepted/In press - Jun 29 2017 |
Fingerprint
Keywords
- Esophagitis
- Gastroesophageal reflux disease
- LINX
- Magnetic sphincter augmentation
- Postoperative outcomes
- Proton pump inhibitors
- Quality of life
ASJC Scopus subject areas
- Surgery
Cite this
Factors influencing the outcome of magnetic sphincter augmentation for chronic gastroesophageal reflux disease. / Warren, Heather F.; Brown, Lisa M; Mihura, Matias; Farivar, Alexander S.; Aye, Ralph W.; Louie, Brian E.
In: Surgical Endoscopy and Other Interventional Techniques, 29.06.2017, p. 1-8.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Factors influencing the outcome of magnetic sphincter augmentation for chronic gastroesophageal reflux disease
AU - Warren, Heather F.
AU - Brown, Lisa M
AU - Mihura, Matias
AU - Farivar, Alexander S.
AU - Aye, Ralph W.
AU - Louie, Brian E.
PY - 2017/6/29
Y1 - 2017/6/29
N2 - Objectives: Magnetic sphincter augmentation (MSA) is a surgical treatment option for patients with gastroesophageal reflux disease (GERD). MSA consistently improves quality of life, maintains freedom from PPIs, and objectively controls GERD. However, up to 24% of patients did not achieve these outcomes. We sought to identify factors predicting outcomes after MSA placement with the aim of refining selection criteria. Methods: We retrospectively analyzed clinical, endoscopic, manometric, pH data, and intraoperative factors from two databases: Pivotal Trial (N = 99) and our prospectively maintained esophageal database (N = 71). A priori outcomes were defined as excellent (GERD-HRQL <5, no PPI, no esophagitis), good (GERD-HRQL 6–15, no PPI, grade A esophagitis), fair (GERD-HRQL 16 to 25, PPI use, grade B esophagitis), and poor (GERD-HRQL >25, PPI use, grade C/D esophagitis). Univariable and multivariable logistic regression analyses were performed to determine predictors of achieving an excellent/good outcome. Results: A total of 170 patients underwent MSA with a median age of 53 years, [43–60] and a median BMI of 27 (IQR = 24–30). At baseline, 93.5% of patients experienced typical symptoms and 69% atypical symptoms. Median DeMeester score was 37.9 (IQR 27.9–51.2) with a structurally intact sphincter in 47%. Esophagitis occurred in 43%. At 48 [19–60] months after MSA, excellent outcomes were achieved in 47%, good in 28%, fair in 22%, and poor in 3%. Median DeMeester score was 15.6 (IQR = 5.8–26.6), esophagitis in 17.6% and daily PPI use in 17%. At univariable analysis, excellent/good outcomes were negatively impacted by BMI, preoperative LES residual pressure, Hill grade, and hiatal hernia. At multivariable analysis, BMI >35 (OR = 0.05, 0.003–0.78, p = 0.03), structurally defective LES (OR = 0.37, 0.13–0.99, p = 0.05), and preoperative LES residual pressure (OR = 0.89, 0.80–0.98, p = 0.02) were independent negative predictors of excellent/good outcome. Conclusions: Magnetic sphincter augmentation results in excellent/good outcomes in most patients but a higher BMI, structurally defective sphincter, and elevated LES residual pressure may prevent this goal.
AB - Objectives: Magnetic sphincter augmentation (MSA) is a surgical treatment option for patients with gastroesophageal reflux disease (GERD). MSA consistently improves quality of life, maintains freedom from PPIs, and objectively controls GERD. However, up to 24% of patients did not achieve these outcomes. We sought to identify factors predicting outcomes after MSA placement with the aim of refining selection criteria. Methods: We retrospectively analyzed clinical, endoscopic, manometric, pH data, and intraoperative factors from two databases: Pivotal Trial (N = 99) and our prospectively maintained esophageal database (N = 71). A priori outcomes were defined as excellent (GERD-HRQL <5, no PPI, no esophagitis), good (GERD-HRQL 6–15, no PPI, grade A esophagitis), fair (GERD-HRQL 16 to 25, PPI use, grade B esophagitis), and poor (GERD-HRQL >25, PPI use, grade C/D esophagitis). Univariable and multivariable logistic regression analyses were performed to determine predictors of achieving an excellent/good outcome. Results: A total of 170 patients underwent MSA with a median age of 53 years, [43–60] and a median BMI of 27 (IQR = 24–30). At baseline, 93.5% of patients experienced typical symptoms and 69% atypical symptoms. Median DeMeester score was 37.9 (IQR 27.9–51.2) with a structurally intact sphincter in 47%. Esophagitis occurred in 43%. At 48 [19–60] months after MSA, excellent outcomes were achieved in 47%, good in 28%, fair in 22%, and poor in 3%. Median DeMeester score was 15.6 (IQR = 5.8–26.6), esophagitis in 17.6% and daily PPI use in 17%. At univariable analysis, excellent/good outcomes were negatively impacted by BMI, preoperative LES residual pressure, Hill grade, and hiatal hernia. At multivariable analysis, BMI >35 (OR = 0.05, 0.003–0.78, p = 0.03), structurally defective LES (OR = 0.37, 0.13–0.99, p = 0.05), and preoperative LES residual pressure (OR = 0.89, 0.80–0.98, p = 0.02) were independent negative predictors of excellent/good outcome. Conclusions: Magnetic sphincter augmentation results in excellent/good outcomes in most patients but a higher BMI, structurally defective sphincter, and elevated LES residual pressure may prevent this goal.
KW - Esophagitis
KW - Gastroesophageal reflux disease
KW - LINX
KW - Magnetic sphincter augmentation
KW - Postoperative outcomes
KW - Proton pump inhibitors
KW - Quality of life
UR - http://www.scopus.com/inward/record.url?scp=85021710112&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85021710112&partnerID=8YFLogxK
U2 - 10.1007/s00464-017-5696-5
DO - 10.1007/s00464-017-5696-5
M3 - Article
C2 - 28664433
AN - SCOPUS:85021710112
SP - 1
EP - 8
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
SN - 0930-2794
ER -