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

doi:10.12998/wjcc.v8.i2.294

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

World J Clin Cases. 2020 Jan 26;8(2):294-305. doi: 10.12998/wjcc.v8.i2.294.

Affiliations

¹ 1 Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens 11527, Greece.
² 4 Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 11527, Greece.
³ 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.
⁴ Department of Surgery, School of Medicine, European University Cyprus, Nicosia 2404, Cyprus.
⁵ Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig 04103, Germany.
⁶ Department of Surgery, Duke University Medical Center, Duke University, Durham, NC 27705, United States. dimmoris@yahoo.com.

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.