IS Case 557: LINX anti-reflux device
Imaging Sciences URMC 2010
Publication Date: 2010-09-25
History
Patient is a 53-year-old male with over 35 year history of gastroesophageal (GE) reflux symptoms, only partially responsive to proton pump inhibitors (PPI).
Findings
LINX anti-reflux device at the distal esophagus, just above the stomach, at the GE junction.
Diagnosis
LINX anti-reflux device
Discussion
Heartburn is a common problem in the United States and in the Western world. Approximately 7% of the population experience symptoms of heartburn daily. In gastroesophageal reflux disease (GERD), the lower esophageal sphincter (LES) relaxes too frequently, which allows stomach acid to reflux into the esophagus. In many cases the symptoms are controlled by lifestyle modifications and proper use of over-the-counter antacids. Despite treatment serious complications can occur, such as Barrett’s esophagus and adenocarcinoma. For patients with symptoms that are not completely controlled by PPI therapy or who desire definitive, one-time treatment, or patients with complications of GERD are considered for surgical treatment. Laparoscopic Nissen fundoplication is usually the procedure of choice, however there is variable response to the procedure, as well as multiple complications post op.
Because of the high prevalence of GERD there has been an increase in development of new treatment modalities. The Magnetic Sphincter Augmentation device (MSA), also known as the LINX anti-reflux device, is a laparoscopically implantable device that is designed to restore LES barrier function using magnetic force. The device requires minimal surgical dissection, maintains normal gastroesophageal junction and gastric anatomy, and is designed to preserve physiologic functions such as vomiting and belch. Patients who fail medical therapy but have normal anatomy of the esophagogastric junction (EGJ) are candidates for MSA. The MSA device consists of a series of titanium beads with a magnetic core. The beads are linked together with independent titanium arms to form a flexible bracelet that is placed around the lower esophagus sphincter. The magnetic attraction of the beads provides continuous force to maintain the LES barrier. The LINX device accommodates a normal swallow function by expanding with each swallowed bolus.
Feasibility clinical trial was conducted to evaluate safety and efficacy of MSA [2]. The conclusion of the study was that laparoscopic implant of the MSA device is safe, well tolerated, requires minimal surgical dissection and has far less complications compared to the conventional Nissen fundoplication.
References
- DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 1999 Jun;94(6):1434-42.
- Bonavina L, Saino GI, Bona D, et al. Magnetic augmentation of the lower esophageal sphincter: results of a feasibility clinical trial. J Gastrointest Surg. 2008 Dec;12(12):2133-40.
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