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.
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。