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MAGNETIC SPHINCTER AUGMENTATION IMPROVES LOWER ESOPHAGEAL SPHINCTER PRESSURE WHILE MAINTAINING ESOPHAGEAL FUNCTION
Kirsten Newhams^*, Anne Meslang, Adam Alleyne, Samantha Martin, Kristy Chovanec, Philip Jackson, Emily Smith, Ali H. Zaidi, Blair A. Jobe
Western Pennsylvania Hospital, Pittsburgh, PA
Background: Nearly 7 million people are afflicted with gastroesophageal reflux disease (GERD). Previous surgical devices that augmented the lower esophageal sphincter ultimately impaired esophageal function, resulting in poor outcomes. Magnetic sphincter augmentation is a relatively new approach to the treatment of GERD that focuses on restoring normal lower esophageal sphincter tone while maintaining esophageal function.
Aim: To demonstrate that magnetic sphincter augmentation improves the lower esophageal sphincter (LES) tone without compromising esophageal function.
Patients and Methods: Retrospective case review of a prospectively maintained database. With IRB approval, data was evaluated on a total of 366 patients who underwent magnetic sphincter augmentation. Thus far, a total of 39 patients have undergone complete manometry preoperatively and at their 1 year postoperative follow up. Discrete manometric parameters were compared preoperatively and postoperatively, including the mean scores for each variable. Additionally, patients completed a dysphagia questionnaire, which was included in the analysis. The mean preoperative and postoperative dysphagia score as well as the percent change in score are documented.
Results: There was a significant improvement in both the residual LES and resting LES pressures from 6.6 to 13.3 mm Hg (p=.0001) on a paired t-test that persisted with a non-parametric evaluation using Wilcoxon Signed Ranked Test (p= .040 for resting LES pressure and p=.0002 for residual pressure). The distal contractile integral (DCI) had a significant mean increase from 2255 mm Hg preoperatively to 2665 mm Hg postoperatively (p=.03); however, this significance did not persist on non-parametric testing (p=.0957). Following magnetic sphincter augmentation, there were no statistically significant changes in peristalsis or intrabolus pressure. The dysphagia index score was obtained on 36 patients pre and postoperatively. 30 patients had reduced dysphagia (83.3%) with an average improvement of 5.9 in the score. 5 patients reported worse dysphagia postoperatively with an average score increase of 3.9. There was 1 patient with no change in dysphagia.
Conclusion: Magnetic sphincter augmentation improves lower esophageal sphincter tone and dysphagia without significantly impacting esophageal function. A detailed dataset will be presented in full at Digestive Disease Week, 2018.

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