Backgrounds

Magnetic sphincter augmentation (MSA) is a newly-developed procedure for refractory gastroesophageal reflux disease (rGERD). A systematic review with meta-analysis was conducted to determine its effectiveness in rGERD.

Methods

Electronic search was performed in Pubmed, Cochrane Library, Embase, Web of Science, Opengrey and ClincalTrials.gov up to April 2020. Single-arm studies evaluating the efficacy and safety of MSA in rGERD or comparative studies with proton pump inhibitor (PPI) or laparoscopic Nissen fundoplication (LNF) served as control were included. Demographic data，postoperative PPI use，GERD-HRQL (GERD-health related quality of life)，acid exposure time (AET)，adverse events (AEs) were collected. The primary outcome was the rate of postoperative PPI use, and secondary outcomes incorporated postoperative GERD-HRQL, normalization in AET and incidence of procedure-related AEs.

Results

In total, 14 trials involving 1138 participants with rGERD were included: 10 single-arm studies, 1 RCT and 3 cohort studies. After MSA, PPIs withdrawal, significant improvement of GERD-HRQL and normalization of AET were achieved respectively in 87.0%, 88.0% and 75.0% of the patients. The incidence of postoperative dysphagia was 29%, and endoscopic dilation was required in 7.4% of MSA patients. MSA showed a better efficacy in symptom control as compared to PPIs (PPI cessation: 91% vs 0%; GERD-HRQL improvement: 81% vs 8%) and similar effectiveness but a lower risk of gas-bloat syndrome (RR 0.69 [0.51, 0.93]，p=0.01) and better reserved ability to belch (RR 1.48 [0.76, 2.86]，p=0.25) as compared to LNF.

Conclusion

MSA was an effective and safe therapy for rGERD. Well-designed randomized trials that compares the efficacy of MSA with other therapies are needed.