Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
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, Eleni Papoutsi, Vassilis G Giannakoulis, Prodromos Kanavidis, Theodore Liakakos, 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens 11527, Greece
Aikaterini Mastoraki, 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 11527, Greece
Diamantis Tsilimigras, Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH 45830, United States
Dimitrios Ntourakis, Department of Surgery, School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
Orestis Lyros, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig 04103, Germany
Dimitrios Moris, Department of Surgery, Duke University Medical Center, Duke University, Durham, NC 27705, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dimitrios Moris, MD, MSc, PhD, Academic Fellow, Academic Research, Doctor, Research Fellow, Surgeon, Department of Surgery, Duke University Medical Center, Duke University, 2310 Erwin Road, Durham, NC 27705, United States. dimmoris@yahoo.com
Received: November 12, 2019
Peer-review started: November 12, 2019
First decision: November 19, 2019
Revised: December 6, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: January 26, 2020
ARTICLE HIGHLIGHTS
Research background
Gastroesophageal reflux disease (GERD) refers to the reflux of stomach contents causing troublesome symptoms and/or complications. When medical therapy is insufficient, surgical therapy is needed and, until now, Laparoscopic Fundoplication (LF) is the gold-standard method.
Research motivation
Magnetic sphincter augmentation (MSA) using the LINX® reflux management system has recently appeared and questions standard treatments.
Research objectives
The purpose of this review is to investigate the device’s safety and efficacy in resolving GERD symptoms.
Research methods
Our systematic review based on the PRISMA guidelines. From inception to September 2019, we searched Medline, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL databases.
Research results
Overall, a total of 35 studies were included in a total of 2511 MSA patients. 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.
Research conclusions
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.
Research perspectives
MSA with the LINX® device is considered a safe procedure with excellent results. When compared with the gold standard, LF, MSA seems to have similar efficacy and safety profiles. Nonetheless, it also has some distinct advantages. These include shorter operative time, less technical variability, less interventions on the normal anatomy, less bloating symptoms and a better ability to belch or vomit. Moreover, promising results comparing the MSA procedure with double-dose PPIs in moderate-to-severe GERD exist. Overall, the results of our review enforce the notion that the MSA procedure has the potential to bridge the treatment gap between maxed-out dose of medical treatment and LF.
