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Laparoscopic Sphincter Augmentation Device Eliminates Reflux Symptoms and Normalizes Esophageal Acid Exposure: One- and 2-Year Results of a Feasibility Trial

Bonavina, Luigi MD*; DeMeester, Tom MD; Fockens, Paul MD; Dunn, Daniel MD§; Saino, Greta MD*; Bona, Davide MD*; Lipham, John MD; Bemelman, Willem MD; Ganz, Robert A. MD

Annals of Surgery:
doi: 10.1097/SLA.0b013e3181fd879b
Original Articles from the ESA Proceedings
Abstract

Objectives: One- and 2-year evaluation of a feasibility trial (clinicaltrials.gov registration numbers NCT01057992, NCT01058070, and 01058564) to assess the safety and efficacy of a laparoscopically implanted sphincter augmentation device for the treatment of gastroesophageal reflux disease (GERD).

Methods: A sphincter augmentation device (LINX Reflux Management System; Torax Medical, Shoreview, MN), designed to prevent reflux due to abnormal opening of the lower esophageal sphincter (LES), was laparoscopically implanted at the gastroesophageal junction in 44 patients. At baseline, all patients had abnormal esophageal acid exposure on 24-hour pH monitoring and improved, but persistent, typical GERD symptoms while on acid suppression therapy with proton pump inhibitors (PPIs). The device comprises a miniature string of interlinked titanium beads, with magnetic cores, placed around the gastroesophageal junction. The magnetic bond between adjacent beads augments sphincter competence. The beads temporarily separate to accommodate a swallowed bolus, allow belching or vomiting, and reapproximate to augment the LES in the closed position. Patients were evaluated after surgery by GERD Health-Related Quality of Life symptom score, PPI usage, endoscopy, esophageal manometry, and 24-hour esophageal pH monitoring.

Results: The total mean GERD Health-Related Quality of Life symptom scores improved from a mean baseline value of 25.7 to 3.8 and 2.4 at 1- and 2-year follow-up, representing an 85% and 90% reduction, respectively (P < 0.0001). Complete cessation of PPI use was reported by 90% of patients at 1 year and by 86% of patients at 2 years. Early dysphagia occurred in 43% of the patients and self-resolved by 90 days. One device was laparoscopically explanted for persistent dysphagia without disruption of the anatomy or function of the cardia. There were no device migrations, erosions, or induced mucosal injuries. At 1 and 2 years, 77% and 90% of patients had a normal esophageal acid exposure. The mean percentage time pH was less than 4 decreased from a baseline of 11.9% to 3.1% (P < 0.0001) at 1 year and to 2.4% (P < 0.0001) at 2 years. Patient satisfaction was 87% at 1 year and 86% at 2 years.

Conclusions: The new laparoscopically implanted sphincter augmentation device eliminates GERD symptoms without creating undue side effects and is effective at 1 and 2 years of follow-up.

In Brief

A laparoscopic sphincter augmentation device proved effective control of symptoms and normalization of esophageal acid exposure at one and two years follow-up. Standardized insertion technique, preservation of normal anatomy, consistent outcomes and minimal side effects are the main features of this surgical procedure.

Author Information

*Department of Surgery, University of Milano Medical School, IRCCS Policlinico San Donato, Milan, Italy

Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA

Academic Medical Center, Amsterdam, the Netherlands

§Abbott Northwestern Hospital, Minneapolis, MN

Minnesota Gastroenterology, Minneapolis, MN.

Reprints: Luigi Bonavina, MD, Department of Surgery, University of Milano, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milan 20097, Italy. E-mail: luigi.bonavina@unimi.it.

Presented at the European Surgical Association Annual Meeting, Budapest, Hungary, 2010.

© 2010 Lippincott Williams & Wilkins, Inc.