Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, PA.
Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, PA.
J Am Coll Surg. 2020 May;230(5):733-743. doi: 10.1016/j.jamcollsurg.2020.01.026. Epub 2020 Feb 17.
Magnetic sphincter augmentation (MSA) is a promising surgical treatment for patients with GERD. The aim of this study was to evaluate the outcomes of MSA in a large cohort of patients with GERD and to determine the factors predicting a favorable outcome.
This was a retrospective review of prospectively collected data of 553 patients who underwent MSA at our institution in a 5-year period. Preoperative clinical, endoscopic, manometric, and pH data were used in a univariate analysis. This was followed by a regression multivariable analysis to determine the factors predicting a favorable outcome. Favorable outcome was defined as freedom from proton pump inhibitors and ≥50% improvement in Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) total score.
At a mean (SD) follow-up of 10.3 (10.6) months after MSA, 92.7% of the patients were free of proton pump inhibitor use and 84% reported at least 50% improvement in their GERD-HRQL total score. The GERD-HRQL total score was improved from a mean (SD) baseline value of 33.8 (18.7) to 7.2 (9.0) (p < 0.001) and 76.1% of the patients had normalization of their esophageal acid exposure. Independent predictors of a favorable outcome after MSA included age younger than 45 years (odds ratio [OR] 4.2; 95% CI, 1.1 to 15.2; p = 0.0305), male sex (OR 2.5; 95% CI, 1.1 to 5.7; p = 0.0301), GERD-HRQL total score >15 (OR 7.5; 95% CI, 3.3 to 16.8; p < 0.0001), and abnormal DeMeester score (OR, 2.6; 95% CI, 1.1 to 5.7; p = 0.0225).
In this largest single-institution series, we demonstrate that MSA implantation is associated with very good clinical and objective outcomes. Age younger than 45 years, male sex, GERD-HRQL total score >15, and abnormal DeMeester score are the 4 preoperative factors predicting a favorable outcome and can be used in patient counseling and MSA use.
磁括约肌增强术（MSA）是一种有前途的胃食管反流病（GERD）治疗方法。本研究的目的是评估 MSA 在一大群 GERD 患者中的结果，并确定预测良好结果的因素。
这是对我们机构在 5 年期间接受 MSA 的 553 名患者的前瞻性收集数据进行的回顾性分析。使用术前临床、内镜、测压和 pH 数据进行单因素分析。随后进行回归多变量分析，以确定预测良好结果的因素。良好的结果定义为无质子泵抑制剂和胃食管反流病相关健康相关生活质量（GERD-HRQL）总评分至少改善 50%。
在 MSA 后平均（SD）10.3（10.6）个月的随访中，92.7%的患者无需使用质子泵抑制剂，84%的患者报告 GERD-HRQL 总评分至少改善 50%。GERD-HRQL 总评分从基线的 33.8（18.7）改善至 7.2（9.0）（p<0.001），76.1%的患者食管酸暴露正常。MSA 后良好结果的独立预测因素包括年龄小于 45 岁（优势比[OR]4.2；95%CI，1.1 至 15.2；p=0.0305）、男性（OR 2.5；95%CI，1.1 至 5.7；p=0.0301）、GERD-HRQL 总评分>15（OR 7.5；95%CI，3.3 至 16.8；p<0.0001）和异常德梅斯特评分（OR，2.6；95%CI，1.1 至 5.7；p=0.0225）。
在这项最大的单机构系列研究中，我们证明 MSA 植入与非常好的临床和客观结果相关。年龄小于 45 岁、男性、GERD-HRQL 总评分>15 和异常德梅斯特评分是预测良好结果的 4 个术前因素，可以用于患者咨询和 MSA 应用。
