THE IMPACT OF MAGNETIC SPHINCTER AUGMENTATION ON GASTRIC EMPTYING
Sven Eriksson*1, Inanc Sarici1, Ping Zheng1, Xinxin Shen1, Ashten N. Omstead1, Blair Jobe1,2, Shahin Ayazi1,2
1Esophageal Institute, Allegheny Health Network, Pittsburgh, PA; 2Department of Surgery, Drexel University, Philadelphia, PA
Introduction:
Magnetic sphincter augmentation (MSA) is an effective alternative to fundoplication with reduced rates of gas-bloat and preserved ability to belch. This suggests a comparatively modest impact on gastric physiology. However, there is paucity of objective gastric physiology data after MSA. The current study aims to assess the impact of MSA on gastric emptying.
Methods:
This was a retrospective review of prospectively collected data from patients with no history of pyloroplasty who underwent gastric emptying scintigraphy (GES) before and after MSA between 2016 and 2021. Delayed gastric emptying (DGE) was defined as 4-hour percent retention >10%. Rapid gastric emptying was defined as 1-hour percent retention <30%. Patients completed the GERD-HRQL questionnaire and pH-monitoring preoperatively and at 12 months postoperatively. Normalization of esophageal acid exposure was defined as DeMeester score <14.7.
Results:
The final study population consisted of 55 patients (74.6% female) with a mean (SD) age of 51.6 (13.1) and BMI of 29.6 (5.0). At a mean (SD) follow up of 13.7 (3.8) months, median (IQR) GERD-HRQL score decreased from 39 (25-53) to 14 (5-26) (p<0.001), 90.2% of patients were free from use of proton pump inhibitors (PPI) and 71.1% had normalization of esophageal acid exposure. Median (IQR) 4-hour retention on GES was similar before and after MSA [1.0 (0.0-3.0) to 1.0 (0.0-6.0), p=0.702]. There were 5 (9.1%) patients with preoperative DGE, of which all normalized after MSA. However, of the 50 (90.9%) patients with normal preoperative GES, 6 (12.0%) patients developed de novo postoperative DGE. There was no significant change in the prevalence of DGE (p=0.782). There was no correlation between pre- and postoperative 4-hour retention (p=0.788).
Median (IQR) 1-hour retention significantly decreased after MSA [68.0 (56.0-83.0) to 56.8 (40.0-72.0), p=0.001]. There was a significant increase in the number of patients with rapid gastric emptying from 0 (0%) to 6 (10.9%), p=0.008. Figure 1 shows a direct correlation between pre- and postoperative 1-hour retention [R: 0.366 95%CI (0.11-0.58), p=0.006].
Patients with preoperative DGE had similar postoperative GERD-HRQL scores (p=0.097), PPI use (p=1.000), and pH normalization (0.308) compared to those without DGE. Patients with postoperative normal, de novo rapid, and de novo delayed gastric emptying had similar GERD-HRQL scores (p=0.122), PPI use (p=0.489) and pH normalization (0.168).
Conclusion:
Magnetic sphincter augmentation resulted in resolution of preoperative delayed gastric emptying in all patients. However, due to de novo postoperative DGE, there is no net effect on the prevalence of DGE. Early gastric emptying was enhanced with 10.9% developing de novo rapid gastric emptying. Antireflux outcomes at 1-year after MSA were unaffected by preoperative gastric emptying status.
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