LINX® reflux management system to bridge the "treatment gap" in gastroesophageal reflux disease: A systematic review of 35 studies

Dimitrios Schizas, Aikaterini Mastoraki, Eleni Papoutsi, Vassilis G Giannakoulis, Prodromos Kanavidis, Diamantis Tsilimigras, Dimitrios Ntourakis, Orestis Lyros, Theodore Liakakos, Dimitrios Moris, Dimitrios Schizas, Aikaterini Mastoraki, Eleni Papoutsi, Vassilis G Giannakoulis, Prodromos Kanavidis, Diamantis Tsilimigras, Dimitrios Ntourakis, Orestis Lyros, Theodore Liakakos, Dimitrios Moris

Abstract

Background: Gastroesophageal reflux disease (GERD) occurs when the reflux of stomach contents causes troublesome symptoms and/or complications. When medical therapy is insufficient, surgical therapy is indicated and, until now, Laparoscopic fundoplication (LF) constitutes the gold-standard method. However, magnetic sphincter augmentation (MSA) using the LINX® Reflux Management System has recently emerged and disputes the standard therapeutic approach.

Aim: To investigate the device's safety and efficacy in resolving GERD symptoms.

Methods: This is a systematic review conducted in accordance to the PRISMA guidelines. We searched MEDLINE, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL databases from inception until September 2019.

Results: Overall, 35 studies with a total number of 2511 MSA patients were included and analyzed. Post-operative proton-pump inhibitor (PPI) cessation rates reached 100%, with less bloating symptoms and a better ability to belch or vomit in comparison to LF. Special patient groups (e.g., bariatric or large hiatal-hernias) had promising results too. The most common postoperative complication was dysphagia ranging between 6% and 83%. Dilation due to dysphagia occurred in 8% of patients with typical inclusion criteria. Esophageal erosion may occur in up to 0.03% of patients. Furthermore, a recent trial indicated MSA as an efficient alternative to double-dose PPIs in moderate-to-severe GERD.

Conclusion: The findings of our review suggest that MSA has the potential to bridge the treatment gap between maxed-out medical treatment and LF. However, further studies with longer follow-up are needed for a better elucidation of these results.

Keywords: Gastroesophageal reflux disease; Gastroesophageal reflux disease - health - related quality of life; LINX® reflux management system; Magnetic sphincter augmentation.

Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest. No financial support.

©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

Figures

Figure 1
Figure 1
PRISMA flowchart.

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