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Factors influencing the outcome of magnetic sphincter augmentation for chronic gastroesophageal reflux disease.
- Source :
-
Surgical Endoscopy & Other Interventional Techniques . Jan2018, Vol. 32 Issue 1, p405-412. 8p. 5 Charts. - Publication Year :
- 2018
-
Abstract
- <bold>Objectives: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *GASTROESOPHAGEAL reflux treatment
*ALTERNATIVE treatment for gastroesophageal reflux
*HEARTBURN
*ESOPHAGUS diseases
*LOGISTIC regression analysis
*THERAPEUTICS
*ESOPHAGEAL surgery
*CHRONIC diseases
*COMPARATIVE studies
*DATABASES
*GASTROESOPHAGEAL reflux
*HYDROGEN-ion concentration
*LAPAROSCOPY
*MAGNETOTHERAPY
*MAGNETS
*RESEARCH methodology
*MEDICAL cooperation
*QUALITY of life
*QUESTIONNAIRES
*RESEARCH
*PROTON pump inhibitors
*EVALUATION research
*TREATMENT effectiveness
*RETROSPECTIVE studies
*SEVERITY of illness index
*DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 18666817
- Volume :
- 32
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- Surgical Endoscopy & Other Interventional Techniques
- Publication Type :
- Academic Journal
- Accession number :
- 127331302
- Full Text :
- https://doi.org/10.1007/s00464-017-5696-5