Magnetic Sphincter Augmentation for Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a highly prevalent condition that represents a huge burden of disease. First-line treatment is based on acid suppression, usually with proton pump inhibitors (PPI). Although effective in most patients, 30 to 40% of patients on PPI therapy experience only partial relief of symptoms. This is partly because medical therapy focuses on the acid composition of the gastric secretions, but overlooks the primary underlying pathological abnormality in GERD: an incompetent lower esophageal sphincter.

Over the last decade, magnetic sphincter augmentation using the LINX Reflux Management System has emerged as a safe and effective alternative to the established laparoscopic fundoplication in patients with intact esophageal motility. This fundus-sparing procedure is performed laparoscopically and augments the lower esophageal sphincter as a functional barrier to reflux. The implant consists of a series of magnetic beads placed around the esophagogastric junction and is associated with a hiatal hernia repair. As the implant is dynamic and can expand, the procedure is associated with fewer negative side effects such as gas bloat, inability to belch and inability to vomit, commonly associated with fundoplication. Initially used only in patients with no or small hiatal hernia, the utilization of magnetic sphincter augmentation is increasing in patients with larger hiatal hernias and, more recently, in patients with GERD following sleeve gastrectomy or Roux-en-Y gastric bypass.