title: One hundred consecutive patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease: 6 years of clinical experience from a single center.
abstract: BACKGROUND
  This study was undertaken to evaluate our clinical experience during a 6-year period with an implantable device that augments the lower esophageal sphincter for gastroesophageal reflux disease (GERD). The device uses magnetic sphincter augmentation (MSA) to strengthen the antireflux barrier.
  
  
  METHODS
  In a single-center, prospective case series, 100 consecutive patients underwent laparoscopic MSA for GERD between March 2007 and February 2012. Clinical outcomes for each patient were tracked post implantation and compared with presurgical data for esophageal pH measurements, symptom scores, and proton pump inhibitor (PPI) use.
  
  
  RESULTS
  Median implant duration was 3 years (range 378 days to 6 years). Median total acid exposure time was reduced from 8.0% before implant to 3.2% post implant (p < 0.001). The median GERD Health Related Quality of Life score at baseline was 16 on PPIs and 24 off PPIs and improved to a score of 2 (p < 0.001). Freedom from daily dependence on PPIs was achieved in 85% of patients. There have been no long-term complications, such as device migrations or erosions. Three patients had the device laparoscopically removed for persistent GERD, odynophagia, or dysphagia, with subsequent resolution of symptoms.
  
  
  CONCLUSIONS
  Magnetic sphincter augmentation for GERD in clinical practice provides safe and long-term reduction of esophageal acid exposure, substantial symptom improvement, and elimination of daily PPI use. For candidates of antireflux surgery who have been carefully evaluated before surgery to confirm indication for MSA, MSA has become a standard treatment at our institution because control of reflux symptoms and pH normalization can be achieved with minimal side effects and preservation of gastric anatomy.
authors.affiliation: Department of Biomedical Sciences for Health, University of Milano Medical School, Milan, Italy. Electronic address: luigi.bonavina@unimi.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bonavina
authors.forename: Greta
authors.initials: G
authors.lastname: Saino
authors.forename: Davide
authors.initials: D
authors.lastname: Bona
authors.forename: Andrea
authors.initials: A
authors.lastname: Sironi
authors.forename: Veronica
authors.initials: V
authors.lastname: Lazzari
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000628:therapy*; D006801:Humans; D010535:Laparoscopy; D055909:Magnetic Field Therapy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors
keywords: GEJ; GERD; HRQL; Health Related Quality of Life; LES; MSA; PPI; gastroesophageal junction; gastroesophageal reflux disease; lower esophageal sphincter; magnetic sphincter augmentation; proton pump inhibitor