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Abstract
Introduction Magnetic bead oesophageal sphincter augmentation device (MSAD) offers an alternative to tissue fundoplication (TF) in the management of gastro oesophageal reflux disease (GORD). This study evaluates patient decision pathways in selecting one of these surgical options and quality of life based outcomes.
Method Consecutive patients with chronic GORD who underwent surgical intervention for definitive treatment were enrolled in the study. The selection criteria for MSAD procedure included objective evidence of GORD, good oesophageal motility, absence of a large hiatus hernia and long segment Barrett’s oesophagus. Pre-operative symptoms, oesophageal physiology, pre-operative and one year post-operative reflux related quality of life scores (HRQL) and the reason for selection of a surgical technique were obtained from a prospective database. Comparative analysis between the MSAD and the TF group was performed.
Results A total of 80 patients were included in the study. Forty six patients were suitable for MSAD, of which 44 (96%) elected to undergo the procedure. Thirty four patients failed to meet the inclusion criteria for MSAD and underwent TF, along with 2 patients who preferred to be treated with TF despite suitability for MSAD.
Distal oesophageal acid exposure was significantly higher in the TF group (DeMeester score median 52.6 [22–74]) than in the MSAD group (DeMeester score median 34.4 [16–55] (p = 0.011). The HRQL score however were similar for both groups (TF 23.9; MSAD 25.8; p = 0.55).
MSAD patients felt the main reason for choosing the procedure was becasue it was less invasive,(30/44, 71%) and secondarily because they perceived it to be associated with less side effects (5/44, 11%). In the TF group 24 patients (64%) felt that the surgeon had influenced their choice of procedure, of which 22 (94%) would have chosen MSAD had they been suitable. Four patients however (11%) chose TF because it was an established procedure with extensive experience.
Patient reported reasoning when preferring either LINX procedure or Tissue Fundoplication
Conclusion Suitability for MSAD was found in 57.5% of patients with objective evidence of GORD.
The perception that it represents a less invasive, less problematic but definitive procedure, is an attractive option for patients who may not otherwise have considered more radical surgery.
There was no clear correlation with the extent of distal oesophageal acid exposure and the impact of this on patient health related quality of life, suggesting that debilitating symptoms can still occur with relatively modest degrees of reflux.
The option of MSAD as a sphincter augmentation rather than a gastric reconstruction procedure may broaden the spectrum of patients willing to undergo surgical rather than medical therapy.
Disclosure of interest None Declared.