Magnetic Sphincter Augmentation Reduces Esophagitis Among Patients With Gastroesophageal Reflux Disease

Endoscopy of the esophagus showing grade 2 esophagitis
A team of investigators conducted a retrospective review to assess the efficacy of magnetic sphincter augmentation for gastroesophageal reflux disease.

Researchers at Allegheny Health Network in the United States observed significant clinical improvement among patients with gastroesophageal reflux disease (GERD) treated with magnetic sphincter augmentation (MSA), according to study findings published in the Journal of the American College of Surgeons.

Patients (N=334) who underwent MSA with LINX® devices for GERD or laryngopharyngeal reflux at their centers between 2013 and 2017 were included in this study. Patients were monitored for esophageal pH or impedance-pH and stratified by DeMeester scores. Follow-up visits occurred at 2 weeks, 6 weeks, 6 months, and yearly.

Patients were aged mean 53.1 (standard deviation [SD], 13.8) years, 39.8% were men, 85.0% had heartburn, 71.9% had hiatal hernia, 70.0% regurgitation, 48.2% had esophagitis, 34.2% had dysphagia, 20.7% had large or paraesophageal hernia, and 89.0% were using proton pump inhibitors.

Stratified by mild (DeMeester <50) or severe (DeMeester ³50) GERD, patients differed significantly for gender (men: 37.2% vs 51.7%; P =.0424), esophagitis (44.2% vs 66.7%; P =.0017), and large or paraesophageal hernia (16.4% vs 40%; P =.0005). Patients with severe GERD had significantly smaller lower esophageal sphincters (LES; P =.0251), LES intra-abdominal length (P =.0271), LES resting pressure (P <.0001), integrated relaxation pressure (P =.0003), distal contractile integral (P =.0035), and distal contraction amplitude (P =.0312).

Larger devices were used during surgery in patients with severe GERD (15 vs 14 beads; P =.0003). No differences were observed for procedure complication (P =.5453) or same-day discharge (P =.64) rates.

At follow-up, symptoms of GERD had significantly improved among all patients; specifically, elimination of heartburn (94.4% vs 90.0%; P =.436) and regurgitation (93.0% vs 94.4%; P =.722) was reported by patients with mild and severe disease, respectively.

Following the procedure, patients with mild and severe disease no longer differed significantly for LES length (P =.4294), LES intra-abdominal lengths (P =.9419), LES resting pressure (P =.1426), integrated relaxation pressure (P =.3398), distal contractile integrals (P =.2557), or distal contraction amplitude (P =.1803).

This study may have been limited by not including a control group.

These data indicated that MSA with a LINX device allowed for clinical improvements among both patients with mild and severe GERD symptoms by effectively reducing esophagitis and eliminating heartburn and regurgitation.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Schwameis K, Ayazi S, Zheng P, et al. Efficacy of magnetic sphincter augmentation across the Spectrum of GERD disease severity. J Am Coll Surg. 2020;S1072-7515(20)32518-7. doi:10.1016/j.jamcollsurg.2020.11.012