Loosening the belt on magnetic sphincter augmentation indications: does body mass index matter?
Background Magnetic sphincter augmentation (MSA) is an effective treatment for gastroesophageal reflux disease (GERD). However, the impact of obesity on MSA outcomes is unknown. The objective of this study was to evaluate the effectiveness of MSA in patients with GERD and obesity. Methods A retrospe...
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Published in | Surgical endoscopy Vol. 36; no. 7; pp. 4878 - 4884 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
01.07.2022
Springer Nature B.V |
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Abstract | Background
Magnetic sphincter augmentation (MSA) is an effective treatment for gastroesophageal reflux disease (GERD). However, the impact of obesity on MSA outcomes is unknown. The objective of this study was to evaluate the effectiveness of MSA in patients with GERD and obesity.
Methods
A retrospective cohort study was performed of consecutive patients who underwent laparoscopic MSA at three high-volume centers from 2016 to 2019. Patients were grouped into four cohorts according to the World Health Organization body mass index (BMI) classification: BMI < 25 (normal weight), BMI 25–29.9 (overweight), BMI 30–34.9 (obese class I), and BMI > 35 (obese class II–III). Preoperative, operative, and postoperative data were compared between groups.
Results
A total of 621 patients underwent laparoscopic MSA during the study period. Follow-up with endoscopy or video esophagram was available for 361 patients (58%) with a median follow-up of 15.4 months. Baseline characteristics of the groups were similar except the BMI > 35 group had more females and a higher preoperative median DeMeester score. There were no significant differences in outcomes between normal weight, overweight, and obese patient groups undergoing MSA. All groups experienced significant reductions in acid suppressive medication use, low GERD-HRQL scores, low DeMeester scores, few intraoperative and postoperative complications, and low rates of hiatal hernia recurrence after MSA.
Conclusions
Magnetic sphincter augmentation is safe and effective in improving GERD symptoms, reducing esophageal acid exposure, and preventing hiatal hernia recurrence, irrespective of patient BMI. MSA should be considered an acceptable treatment option for obese patients with GERD. |
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AbstractList | BACKGROUNDMagnetic sphincter augmentation (MSA) is an effective treatment for gastroesophageal reflux disease (GERD). However, the impact of obesity on MSA outcomes is unknown. The objective of this study was to evaluate the effectiveness of MSA in patients with GERD and obesity. METHODSA retrospective cohort study was performed of consecutive patients who underwent laparoscopic MSA at three high-volume centers from 2016 to 2019. Patients were grouped into four cohorts according to the World Health Organization body mass index (BMI) classification: BMI < 25 (normal weight), BMI 25-29.9 (overweight), BMI 30-34.9 (obese class I), and BMI > 35 (obese class II-III). Preoperative, operative, and postoperative data were compared between groups. RESULTSA total of 621 patients underwent laparoscopic MSA during the study period. Follow-up with endoscopy or video esophagram was available for 361 patients (58%) with a median follow-up of 15.4 months. Baseline characteristics of the groups were similar except the BMI > 35 group had more females and a higher preoperative median DeMeester score. There were no significant differences in outcomes between normal weight, overweight, and obese patient groups undergoing MSA. All groups experienced significant reductions in acid suppressive medication use, low GERD-HRQL scores, low DeMeester scores, few intraoperative and postoperative complications, and low rates of hiatal hernia recurrence after MSA. CONCLUSIONSMagnetic sphincter augmentation is safe and effective in improving GERD symptoms, reducing esophageal acid exposure, and preventing hiatal hernia recurrence, irrespective of patient BMI. MSA should be considered an acceptable treatment option for obese patients with GERD. Background Magnetic sphincter augmentation (MSA) is an effective treatment for gastroesophageal reflux disease (GERD). However, the impact of obesity on MSA outcomes is unknown. The objective of this study was to evaluate the effectiveness of MSA in patients with GERD and obesity. Methods A retrospective cohort study was performed of consecutive patients who underwent laparoscopic MSA at three high-volume centers from 2016 to 2019. Patients were grouped into four cohorts according to the World Health Organization body mass index (BMI) classification: BMI < 25 (normal weight), BMI 25–29.9 (overweight), BMI 30–34.9 (obese class I), and BMI > 35 (obese class II–III). Preoperative, operative, and postoperative data were compared between groups. Results A total of 621 patients underwent laparoscopic MSA during the study period. Follow-up with endoscopy or video esophagram was available for 361 patients (58%) with a median follow-up of 15.4 months. Baseline characteristics of the groups were similar except the BMI > 35 group had more females and a higher preoperative median DeMeester score. There were no significant differences in outcomes between normal weight, overweight, and obese patient groups undergoing MSA. All groups experienced significant reductions in acid suppressive medication use, low GERD-HRQL scores, low DeMeester scores, few intraoperative and postoperative complications, and low rates of hiatal hernia recurrence after MSA. Conclusions Magnetic sphincter augmentation is safe and effective in improving GERD symptoms, reducing esophageal acid exposure, and preventing hiatal hernia recurrence, irrespective of patient BMI. MSA should be considered an acceptable treatment option for obese patients with GERD. Magnetic sphincter augmentation (MSA) is an effective treatment for gastroesophageal reflux disease (GERD). However, the impact of obesity on MSA outcomes is unknown. The objective of this study was to evaluate the effectiveness of MSA in patients with GERD and obesity. A retrospective cohort study was performed of consecutive patients who underwent laparoscopic MSA at three high-volume centers from 2016 to 2019. Patients were grouped into four cohorts according to the World Health Organization body mass index (BMI) classification: BMI < 25 (normal weight), BMI 25-29.9 (overweight), BMI 30-34.9 (obese class I), and BMI > 35 (obese class II-III). Preoperative, operative, and postoperative data were compared between groups. A total of 621 patients underwent laparoscopic MSA during the study period. Follow-up with endoscopy or video esophagram was available for 361 patients (58%) with a median follow-up of 15.4 months. Baseline characteristics of the groups were similar except the BMI > 35 group had more females and a higher preoperative median DeMeester score. There were no significant differences in outcomes between normal weight, overweight, and obese patient groups undergoing MSA. All groups experienced significant reductions in acid suppressive medication use, low GERD-HRQL scores, low DeMeester scores, few intraoperative and postoperative complications, and low rates of hiatal hernia recurrence after MSA. Magnetic sphincter augmentation is safe and effective in improving GERD symptoms, reducing esophageal acid exposure, and preventing hiatal hernia recurrence, irrespective of patient BMI. MSA should be considered an acceptable treatment option for obese patients with GERD. |
Author | James, Tayler J. Putnam, Luke R. Pan, Jennifer Bildzukewicz, Nikolai A. Bell, Reginald Lipham, John C. Burke, Jocelyn F. |
Author_xml | – sequence: 1 givenname: Tayler J. surname: James fullname: James, Tayler J. organization: Keck Medical Center of University of Southern California – sequence: 2 givenname: Jocelyn F. surname: Burke fullname: Burke, Jocelyn F. organization: Institute of Esophageal and Reflux Surgery – sequence: 3 givenname: Luke R. surname: Putnam fullname: Putnam, Luke R. organization: Keck Medical Center of University of Southern California – sequence: 4 givenname: Jennifer surname: Pan fullname: Pan, Jennifer organization: Keck Medical Center of University of Southern California – sequence: 5 givenname: Nikolai A. surname: Bildzukewicz fullname: Bildzukewicz, Nikolai A. organization: Keck Medical Center of University of Southern California – sequence: 6 givenname: Reginald surname: Bell fullname: Bell, Reginald organization: Institute of Esophageal and Reflux Surgery – sequence: 7 givenname: John C. surname: Lipham fullname: Lipham, John C. email: John.lipham@med.usc.edu organization: Keck Medical Center of University of Southern California |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34750701$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1093_dote_doac109 crossref_primary_10_1007_s00464_024_10672_7 crossref_primary_10_1016_j_gassur_2024_05_013 crossref_primary_10_1093_dote_doac104 crossref_primary_10_1093_dote_doac115 |
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Keywords | Obesity LINX Magnetic sphincter augmentation Gastroesophageal reflux disease |
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Magnetic sphincter augmentation (MSA) is an effective treatment for gastroesophageal reflux disease (GERD). However, the impact of obesity on MSA... Magnetic sphincter augmentation (MSA) is an effective treatment for gastroesophageal reflux disease (GERD). However, the impact of obesity on MSA outcomes is... BackgroundMagnetic sphincter augmentation (MSA) is an effective treatment for gastroesophageal reflux disease (GERD). However, the impact of obesity on MSA... BACKGROUNDMagnetic sphincter augmentation (MSA) is an effective treatment for gastroesophageal reflux disease (GERD). However, the impact of obesity on MSA... |
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SubjectTerms | Abdominal Surgery Body Mass Index Esophageal Sphincter, Lower - surgery Female Gastroenterology Gastroesophageal reflux Gastroesophageal Reflux - complications Gastroesophageal Reflux - surgery Gynecology Hepatology Hernia, Hiatal - surgery Hiatal hernias Humans Laparoscopy Magnetic Phenomena Medicine Medicine & Public Health Obesity Obesity - surgery Overweight Overweight - complications Overweight - surgery Patients Proctology Quality of Life Retrospective Studies Surgery Treatment Outcome |
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Title | Loosening the belt on magnetic sphincter augmentation indications: does body mass index matter? |
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