17 - Freie Mitteilung
15. Mai 2019, 13:30 - 15:00, Bellavista 2, 6. OG
Post-operative dysphagia following magnetic sphincter augmentation for gastroesophageal reflux disease
C. Tsai1, R. Steffen1, H. Merki1, U. Kessler1, J. Lipham2, J. Zehetner1, Presenter: C. Tsai1 (1Bern, 2California/USA)
Gastroesophageal reflux disease (GERD) is the most prevalent gastrointestinal disorder of the esophagus in the Western population. Magnetic lower esophageal sphincter augmentation (MSA) is a treatment technique with promising results. Dysphagia is the most common temporary side effect after MSA, occurring in up to 83% of patients. While most cases self-resolve by 3 months, some persist and require intervention. The aim of this study was to evaluate predictors of persistent post-operative dysphagia leading to intervention, as well as its impact on quality of life.
From August 2015 to September 2018 we reviewed the electronic medical records of all patients with GERD receiving a laparoscopic MSA (LINX reflux management system, Torax Medical) with posterior cruroplasty (PC). Demographic details, procedure details and outcome variables were recorded. Pre- and post-operative GERD-HRQL scores were obtained to assess symptom response. Patients with post-operative dysphagia requiring balloon dilation were identified, and variables were analyzed to asses for risk factors.
There were 118 patients (M=59, F=59) with GERD treated with MSA-PC. Mean age was 50 years (R18-80) and mean duration of symptoms was 10.4 years (R1-40). One patient was converted to a Nissen fundoplication for persistent GERD. Based on GERD-HRQL scores (n=73 responses), 100% of patients had improved symptoms after MSA-PC. Post-operative dysphagia was present in 80 patients (67.8%). Of them, 20 (16.9%) required balloon dilation for persistent dysphagia. Patients received a median of 1 dilation at a mean of 5.6 months (R1-13) after MSA-PC. The MSA device was explanted in two patients, while dysphagia resolved in 15 patients. Two patients have persistent symptoms and the remaining patient has insufficient follow-up. Compared to patients who did not require dilation, dilated patients were more likely to have atypical GERD symptoms pre-operatively. However, 92.3% of non-explanted patients requiring dilation reported an improved quality of life.
Post-operative dysphagia after MSA-PC is a common temporary side effect and most commonly seen in patients with atypical GERD symptoms pre-operatively. Most cases of persistent dysphagia can be treated with a single balloon dilation. Despite requiring dilation, the majority of patients still report an improved quality of life.