Department of Surgery and Cancer, Imperial College London, United Kingdom.
Dis Esophagus. 2019 Nov 13;32(9). doi: 10.1093/dote/doz031.
Magnetic sphincter augmentation (MSA) has been proposed as a less invasive, more appealing alternative intervention to fundoplication for the treatment of gastroesophageal reflux disease (GERD). The aim of this study was to evaluate clinical outcomes following MSA for GERD control in comparison with laparoscopic fundoplication. A systematic electronic search for articles was performed in Medline, Embase, Web of Science, and Cochrane Library for single-arm cohort studies or comparative studies (with fundoplication) evaluating the use of MSA. A random-effects meta-analysis for postoperative proton pump inhibitor (PPI) use, GERD-health-related quality of life (GERD-HRQOL), gas bloating, ability to belch, dysphagia, and reoperation was performed. The systematic review identified 6 comparative studies of MSA versus fundoplication and 13 single-cohort studies. Following MSA, only 13.2% required postoperative PPI therapy, 7.8% dilatation, 3.3% device removal or reoperation, and esophageal erosion was seen in 0.3%. There was no significant difference between the groups in requirement for postoperative PPI therapy (pooled odds ratio, POR = 1.08; 95%CI 0.40-2.95), GERD-HRQOL score (weighted mean difference, WMD = 0.34; 95%CI -0.70-1.37), dysphagia (POR = 0.94; 95%CI 0.57-1.55), and reoperation (POR = 1.23; 95%CI 0.26-5.8). However, when compared to fundoplication MSA was associated with significantly less gas bloating (POR = 0.34; 95%CI 0.16-0.71) and a greater ability to belch (POR = 12.34; 95%CI 6.43-23.7). In conclusion, magnetic sphincter augmentation achieves good GERD symptomatic control similar to that of fundoplication, with the benefit of less gas bloating. The safety of MSA also appears acceptable with only 3.3% of patients requiring device removal. There is an urgent need for randomized data directly comparing fundoplication with MSA for the treatment of GERD to truly evaluate the efficacy of this treatment approach.
磁括约肌增强术 (MSA) 已被提议作为一种侵入性较小、更具吸引力的替代干预措施，用于治疗胃食管反流病 (GERD)，而非胃底折叠术。本研究旨在评估 MSA 治疗 GERD 控制的临床结果，并与腹腔镜胃底折叠术进行比较。在 Medline、Embase、Web of Science 和 Cochrane Library 中进行了系统的电子搜索，以寻找评估 MSA 使用的单臂队列研究或比较研究（与胃底折叠术比较）。对术后质子泵抑制剂 (PPI) 使用、GERD 健康相关生活质量 (GERD-HRQOL)、气体膨满、呃逆能力、吞咽困难和再手术进行了随机效应荟萃分析。系统综述确定了 6 项 MSA 与胃底折叠术的比较研究和 13 项单队列研究。在 MSA 之后，只有 13.2%的患者需要术后 PPI 治疗，7.8%需要扩张，3.3%需要移除或重新手术，0.3%的患者发生食管溃疡。两组在术后 PPI 治疗需求（汇总优势比，POR = 1.08；95%CI 0.40-2.95）、GERD-HRQOL 评分（加权均数差，WMD = 0.34；95%CI -0.70-1.37）、吞咽困难（POR = 0.94；95%CI 0.57-1.55）和再手术（POR = 1.23；95%CI 0.26-5.8）方面无显著差异。然而，与胃底折叠术相比，MSA 与显著较少的气体膨满（POR = 0.34；95%CI 0.16-0.71）和更强的呃逆能力（POR = 12.34；95%CI 6.43-23.7）相关。总之，磁括约肌增强术可实现与胃底折叠术相似的良好 GERD 症状控制，其优点是气体膨满较少。MSA 的安全性似乎也可以接受，只有 3.3%的患者需要移除设备。目前迫切需要直接比较胃底折叠术与 MSA 治疗 GERD 的随机数据，以真正评估这种治疗方法的疗效。
