PDF(Pubmed)
Abstract：
BACKGROUND: Management of gastroesophageal reflux disease after bariatric procedures can be challenging. There are very few long-term studies in this arena. This study aims to evaluate the long-term outcomes of the magnetic sphincter augmentation (MSA) reflux management system in a cohort of bariatric patients who had previously undergone sleeve gastrectomy and Roux-en-Y gastric bypass, with a focus on assessing gastroesophageal reflux disease (GERD) scores, medication use, and patient-reported symptoms.
METHODS: We conducted a retrospective chart review of 16 consecutive bariatric patients who received MSA implants following sleeve gastrectomy (n = 14) or gastric bypass (n = 2) surgeries. Data were collected regarding BMI, GERD quality of life assessments (GERD-HRQL), reflux symptoms, and use of PPIs in the sleeve/RGB patients through an extended period with a mean follow-up of 48 months.
RESULTS: Patients were followed up for a range of .5-84 months. Preoperative assessments included upper gastrointestinal imaging (UGI), high-resolution manometry, Bravo pH studies, and esophagogastroduodenoscopy (EGD). Three patients exhibited reflux on UGI, and 13/13 patients had positive Bravo studies preoperatively. Sixteen patients had a lower esophageal sphincter (LES) pressure under 18 mmHg, and eight patients had biopsy-proven esophagitis. Long-term outcomes are as follows. Daily PPI use fell from 88 to 25% at greater than three years. GERD-HRQL scores fell from 50.6 at baseline (range 27-70) and normalized at long-term follow-up. GERD symptom of regurgitation completely resolved. At long term, two patients had dysphagia and two patients had ongoing reflux. No adverse events were noted.
CONCLUSIONS: This is the first long-term outcomes study of magnetic sphincter augmentation placement after bariatric surgery. Our study showed the majority of patients had long-term improvement in GERD-HRQL scores and resolution/ relief of their reflux symptoms, with decreased use of PPIs. MSA is a safe, effective and durable management tool for reflux after bariatric surgery in carefully selected patients.
METHODS: We conducted a retrospective chart review of 16 consecutive bariatric patients who received MSA implants following sleeve gastrectomy (n = 14) or gastric bypass (n = 2) surgeries. Data were collected regarding BMI, GERD quality of life assessments (GERD-HRQL), reflux symptoms, and use of PPIs in the sleeve/RGB patients through an extended period with a mean follow-up of 48 months.
RESULTS: Patients were followed up for a range of .5-84 months. Preoperative assessments included upper gastrointestinal imaging (UGI), high-resolution manometry, Bravo pH studies, and esophagogastroduodenoscopy (EGD). Three patients exhibited reflux on UGI, and 13/13 patients had positive Bravo studies preoperatively. Sixteen patients had a lower esophageal sphincter (LES) pressure under 18 mmHg, and eight patients had biopsy-proven esophagitis. Long-term outcomes are as follows. Daily PPI use fell from 88 to 25% at greater than three years. GERD-HRQL scores fell from 50.6 at baseline (range 27-70) and normalized at long-term follow-up. GERD symptom of regurgitation completely resolved. At long term, two patients had dysphagia and two patients had ongoing reflux. No adverse events were noted.
CONCLUSIONS: This is the first long-term outcomes study of magnetic sphincter augmentation placement after bariatric surgery. Our study showed the majority of patients had long-term improvement in GERD-HRQL scores and resolution/ relief of their reflux symptoms, with decreased use of PPIs. MSA is a safe, effective and durable management tool for reflux after bariatric surgery in carefully selected patients.
摘要：
背景：减肥手术后胃食管反流病的治疗具有挑战性。在这个领域很少有长期的研究。本研究旨在评估磁性括约肌增强（MSA）反流管理系统在以前接受过袖状胃切除术和Roux-en-Y胃旁路术的减肥患者队列中的长期结果。重点评估胃食管反流病（GERD）评分，药物使用,和患者报告的症状。
方法：我们对16例连续在袖状胃切除术（n=14）或胃旁路术（n=2）后接受MSA植入的肥胖患者进行了回顾性分析。收集了关于BMI的数据，GERD生活质量评估（GERD-HRQL），反流症状,并且在套管/RGB患者中使用PPI，平均随访48个月。
结果：患者随访5-84个月。术前评估包括上消化道造影（UGI），高分辨率测压,BravopH值研究,和食管胃十二指肠镜检查（EGD）。三名患者在UGI上表现出反流，13/13患者术前Bravo研究阳性。16例患者的食管下括约肌（LES）压力低于18mmHg，8例患者有活检证实的食管炎。长期结果如下。每日PPI使用量从88%下降到25%，超过三年。GERD-HRQL评分从基线时的50.6下降（范围27-70），并在长期随访时恢复正常。GERD反流症状完全缓解。从长远来看，2例患者出现吞咽困难,2例患者出现持续反流.没有注意到不良事件。
结论：这是减重手术后磁性括约肌增强放置的第一个长期结果研究。我们的研究表明，大多数患者在GERD-HRQL评分和反流症状的消退/缓解方面有长期改善，减少使用PPI。MSA是保险箱，在精心挑选的患者中，减肥手术后反流的有效和持久的管理工具。
方法：我们对16例连续在袖状胃切除术（n=14）或胃旁路术（n=2）后接受MSA植入的肥胖患者进行了回顾性分析。收集了关于BMI的数据，GERD生活质量评估（GERD-HRQL），反流症状,并且在套管/RGB患者中使用PPI，平均随访48个月。
结果：患者随访5-84个月。术前评估包括上消化道造影（UGI），高分辨率测压,BravopH值研究,和食管胃十二指肠镜检查（EGD）。三名患者在UGI上表现出反流，13/13患者术前Bravo研究阳性。16例患者的食管下括约肌（LES）压力低于18mmHg，8例患者有活检证实的食管炎。长期结果如下。每日PPI使用量从88%下降到25%，超过三年。GERD-HRQL评分从基线时的50.6下降（范围27-70），并在长期随访时恢复正常。GERD反流症状完全缓解。从长远来看，2例患者出现吞咽困难,2例患者出现持续反流.没有注意到不良事件。
结论：这是减重手术后磁性括约肌增强放置的第一个长期结果研究。我们的研究表明，大多数患者在GERD-HRQL评分和反流症状的消退/缓解方面有长期改善，减少使用PPI。MSA是保险箱，在精心挑选的患者中，减肥手术后反流的有效和持久的管理工具。
