Journal article
Magnetic Sphincter Augmentation and Postoperative Dysphagia: Characterization, Clinical Risk Factors, and Management
Journal of gastrointestinal surgery, v 24(1), pp 39-49
01 Jan 2020
PMID: 31388888
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Introduction
Magnetic sphincter augmentation (MSA) results in less severe side effects compared with Nissen fundoplication, but dysphagia remains the most common side effect reported by patients after MSA. This study aimed to characterize and review the management of postoperative dysphagia and identify the preoperative factors that predict persistent dysphagia after MSA.
Material and Methods
This is a retrospective review of prospectively collected data of patients who underwent MSA between 2013 and 2018. Preoperative objective evaluation included upper endoscopy, esophagram, high-resolution impedance manometry (HRIM), and esophageal pH testing. Postoperative persistent dysphagia was defined as a postoperative score of > 3 for the dysphagia-specific item within the GERD-HRQL at a minimum of 3 months following MSA. A timeline of dysphagia and dilation rates was constructed and correlated with the evolution of our patient management practices and modifications in surgical technique.
Results
A total of 380 patients underwent MSA, at a mean (SD) follow up of 11.5 (8.7) months, 59 (15.5%) patients were experiencing persistent dysphagia. Thirty-one percent of patients required at least one dilation for dysphagia or chest pain and the overall response rate to this procedure was 67%, 7 (1.8%) patients required device removal specifically for dysphagia. Independent predictors of persistent dysphagia based on logistic regression model included (1) absence of a large hernia (OR 2.86 (95% CI 1.08–7.57,
p
= 0.035)); (2) the presence of preoperative dysphagia (OR 2.19 (95% CI 1.05–4.58,
p
= 0.037)); and (3) having less than 80% peristaltic contractions on HRIM (OR 2.50 (95% CI 1.09–5.73,
p
= 0.031)). Graded cutoffs of distal contractile integral (DCI), mean wave amplitude, DeMeester score, sex, and body mass index were evaluated within the model and did not predict postoperative dysphagia. Frequent eating after surgery, avoidance of early dilation, and increase in the size of the LINX device selected decreased the need for dilation.
Conclusion
In a large cohort of patients who underwent MSA, we report 15.5% rate of persistent postoperative dysphagia. The overall response rate to dilation therapy is 67%, and the efficacy of dilation with each subsequent procedure reduces. Patients with normal hiatal anatomy, significant preoperative dysphagia, and less than 80% peristaltic contractions of the smooth muscle portion of the esophagus should be counseled that they have an increased risk for persistent postoperative dysphagia.
Metrics
Details
- Title
- Magnetic Sphincter Augmentation and Postoperative Dysphagia: Characterization, Clinical Risk Factors, and Management
- Creators
- Shahin Ayazi - Allegheny Health NetworkPing Zheng - Allegheny Health NetworkAli H. Zaidi - Allegheny Health NetworkKristy Chovanec - Lung InstituteNobel Chowdhury - Allegheny Health NetworkMadison Salvitti - Lung InstituteYoshihiro Komatsu - Allegheny Health NetworkAshten N. Omstead - Allegheny Health NetworkToshitaka Hoppo - Allegheny Health NetworkBlair A. Jobe - Allegheny Health Network
- Publication Details
- Journal of gastrointestinal surgery, v 24(1), pp 39-49
- Publisher
- Springer Nature
- Number of pages
- 11
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000520160900005
- Scopus ID
- 2-s2.0-85070402288
- Other Identifier
- 991022048378804721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Gastroenterology & Hepatology
- Surgery