The Impact of Ineffective Esophageal Motility On Patients Undergoing Magnetic Sphincter Augmentation.

Publication Title

Annals of surgery

Authors

George N Baison, Swedish Cancer Institute, Seattle Washington
Anee Sophia Jackson, Swedish Cancer Institute, Seattle WashingtonFollow
Candice L. Wilshire, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA.Follow
Reginald C W Bell
Veronica Lazzari
Luigi Bonavina
Shahin Ayazi
Blair A Jobe
Sebastian F Schoppmann
Colin P Dunn
John C Lipham
Christy M Dunst
Alexander S Farivar, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Adam J Bograd, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA.Follow
Brian Louie, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow

Document Type

Article

Publication Date

1-25-2022

Keywords

washington; swedish cancer; swedish dhi; swedish digestive health

Abstract

OBJECTIVE: To evaluate and characterize outcomes of magnetic sphincter augmentation (MSA) in patients with ineffective esophageal motility (IEM).

SUMMARY BACKGROUND DATA: MSA improves patients with gastroesophageal reflux and normal motility. However, many patients have IEM, which could impact the outcomes of MSA and discourage use.

METHODS: An international, multi-institutional case control study of IEM patients undergoing MSA matched to normal patients was performed. Primary outcomes were new onset dysphagia and need for postoperative interventions.

RESULTS: A total of 105 IEM patients underwent MSA with matching controls. At 1 year after MSA: GERD-HRQL was similar; DeMeester scores in IEM patients improved to 15.7 and to 8.5 in controls (p = 0.021); and normalization of the DeMeester score for IEM = 61.7% and controls = 73.1% (p = 0.079).In IEM patients, 10/12 (83%) with preop dysphagia had resolution; 11/66 (17%) had new onset dysphagia and 55/66 (83%) never had dysphagia. Comparatively, in non-IEM patients, 22/24 (92%) had dysphagia resolve; 2/24 (8%) had persistent dysphagia; 7/69 (10%) had new onset dysphagia and 62/69 (90%) never had dysphagia.Overall, 19 (18%) IEM patients were dilated after MSA, while 12 (11%) non-IEM patients underwent dilation (p = 0.151). Nine (9%) patients in both groups had their device explanted.

CONCLUSIONS: Patients with IEM undergoing MSA demonstrate improved quality of life and reduction in acid exposure. Key differences in IEM patients include lower rates of objective GERD resolution, lower resolution of existing dysphagia, higher rates of new onset dysphagia and need for dilation. GERD patients with IEM should be counselled about these possibilities.

Clinical Institute

Cancer

Clinical Institute

Digestive Health

Specialty/Research Institute

Gastroenterology

Specialty/Research Institute

Oncology

Specialty/Research Institute

Surgery

DOI

10.1097/SLA.0000000000005369