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LINX® magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis

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Abstract

Background

The LINX® magnetic sphincter augmentation system (MSA) is a surgical technique with short-term evidence demonstrating efficacy in the treatment of medically refractory or chronic gastroesophageal reflux disease (GERD). Currently, the Nissen fundoplication is the gold-standard surgical treatment for GERD. We are the first to systematically review the literature and perform a meta-analysis comparing MSA to the Nissen fundoplication.

Methods

A comprehensive search of electronic databases (e.g., MEDLINE, EMBASE, SCOPUS, Web of Science and the Cochrane Library) using search terms “Gastroesophageal reflux or heartburn” and “LINX or endoluminal or magnetic” and “fundoplication or Nissen” was completed. All randomized controlled trials, non-randomized comparison study and case series with greater than 5 patients were included. Five hundred and forty-seven titles were identified through primary search, and 197 titles or abstracts were screened after removing duplicates. Meta-analysis was performed on postoperative quality of life outcomes, procedural efficacy and patient procedural satisfaction.

Results

Three primary studies identified a total of 688 patients, of whom 273 and 415 underwent Nissen fundoplication and MSA, respectively. MSA was statistically superior to LNF in preserving patient’s ability to belch (95.2 vs 65.9%, p < 0.00001) and ability to emesis (93.5 vs 49.5%, p < 0.0001). There was no statistically significant difference between MSA and LNF in gas/bloating (26.7 vs 53.4%, p = 0.06), postoperative dysphagia (33.9 vs 47.1%, p = 0.43) and proton pump inhibitor (PPI) elimination (81.4 vs 81.5%, p = 0.68).

Conclusion

Magnetic sphincter augmentation appears to be an effective treatment for GERD with short-term outcomes comparable to the more technically challenging and time-consuming Nissen fundoplication. Long-term comparative outcome data past 1 year are needed in order to further understand the efficacy of magnetic sphincter augmentation.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre, 840-112 Street, Edmonton, T6G 2B7, Canada

    Daniel Skubleny, Noah J. Switzer, Jerry Dang, Christopher de Gara, Daniel W. Birch & Shahzeer Karmali

  2. Department of Surgery, Faculty of Medicine and Dentistry, University of Calgary, Calgary, Canada

    Richdeep S. Gill

  3. Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Canada

    Xinzhe Shi, Christopher de Gara, Daniel W. Birch & Shahzeer Karmali

  4. Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada

    Clarence Wong

  5. Department of Surgery, Harvard Medical School, Boston, MA, USA

    Matthew M. Hutter

Authors
  1. Daniel Skubleny
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  2. Noah J. Switzer
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  3. Jerry Dang
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  4. Richdeep S. Gill
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  5. Xinzhe Shi
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  6. Christopher de Gara
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  7. Daniel W. Birch
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  10. Shahzeer Karmali
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Correspondence to Noah J. Switzer.

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Disclosures

Daniel Skubleny, Noah J. Switzer, Jerry Dang, Richdeep S. Gill, Xinzhe Shi, Christopher de Gara, Daniel W. Birch, Clarence Wong, Matthew M. Hutter and Shahzeer Karmali have no conflicts of interest or financial ties to disclose.

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Skubleny, D., Switzer, N.J., Dang, J. et al. LINX® magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc 31, 3078–3084 (2017). https://doi.org/10.1007/s00464-016-5370-3

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  • DOI: https://doi.org/10.1007/s00464-016-5370-3

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