Magnetic Sphincter Augmentation for Laryngopharyngeal Reflux: An Assessment of Efficacy and Predictors of Outcome

Sven E Eriksson; Inanc S Sarici; Ping Zheng; Margaret Gardner; Blair A Jobe; Shahin Ayazi

doi:10.1016/j.jvoice.2024.03.026

Magnetic Sphincter Augmentation for Laryngopharyngeal Reflux: An Assessment of Efficacy and Predictors of Outcome

J Voice. 2024 Apr 18:S0892-1997(24)00098-5. doi: 10.1016/j.jvoice.2024.03.026. Online ahead of print.

Authors

Sven E Eriksson¹, Inanc S Sarici¹, Ping Zheng², Margaret Gardner², Blair A Jobe³, Shahin Ayazi⁴

Affiliations

¹ Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Chevalier Jackson Research Fellowship, Esophageal Institute, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania.
² Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, Pennsylvania.
³ Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Chevalier Jackson Research Fellowship, Esophageal Institute, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania; Department of Surgery, Drexel University, Philadelphia, Pennsylvania.
⁴ Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Chevalier Jackson Research Fellowship, Esophageal Institute, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania; Department of Surgery, Drexel University, Philadelphia, Pennsylvania. Electronic address: shahin.ayazi@ahn.org.

PMID: 38641520
DOI: 10.1016/j.jvoice.2024.03.026

Abstract

Introduction: Magnetic sphincter augmentation (MSA) is an effective treatment for typical reflux symptoms, but data on its impact on laryngopharyngeal reflux (LPR) is limited. This study aimed to determine the efficacy of MSA for LPR and to identify predictors of outcome.

Methods: This was a retrospective review of 775 patients who underwent MSA between 2013 and 2021. LPR was defined as presence of atypical reflux symptoms and a reflux symptom index (RSI) score >13. Favorable outcome was defined as primary symptom resolution, freedom from proton pump inhibitors, and five-point improvement or RSI score normalization. Preoperative clinical, high-resolution manometry, and impedance-pH data were analyzed for impact on favorable outcome using univariate followed by multivariable analysis.

Results: There were 128 patients who underwent MSA for LPR. At a mean (SD) follow-up of 13 (5.4) months, favorable outcome was achieved by 80.4% of patients, with median (IQR) RSI score improving from 29 (22-35) to 9 (4-17), (P < 0.001). Independent predictors of favorable outcome on multivariable analysis included LPR with typical reflux symptoms [OR (95% CI): 8.9 (2.3-31.1), P = 0.001], >80% intact swallow on high-resolution manometry [OR (95% CI): 3.8 (1.0-13.3), P = 0.035], upper esophageal sphincter (UES) resting pressure >34 mmHg [OR (95% CI): 4.1 (1.1-14.1), P = 0.027] and short total proximal acid clearance time [OR (95% CI): 1.1 (1.0-1.1), P = 0.031]. Impedance parameters including number of LPR events, full column reflux and proximal acid exposure events were similar between outcome groups (P > 0.05).

Conclusion: MSA is an effective surgery for patients with LPR. Patients with concomitant typical reflux symptoms, normal esophageal body motility, and competent UES benefit the most from surgery. Individual impedance-pH parameters were not associated with outcome.

Keywords: Esophageal motility; Laryngopharyngeal reflux; Magnetic sphincter augmentation; Typical reflux symptoms; Upper esophageal sphincter.