Minireviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2019; 11(8): 472-476
Published online Aug 16, 2019. doi: 10.4253/wjge.v11.i8.472
Magnetic sphincter augmentation: Optimal patient selection and referral care pathways
F Paul Buckley, Benjamin Havemann, Amarpreet Chawla
F Paul Buckley, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, United States
Benjamin Havemann, Austin Gastroenterology, Bee Cave, TX 78738, United States
Amarpreet Chawla, Department of Health Economics and Market Access, Ethicon Inc. (Johnson and Johnson), Cincinnati, OH 45242, United States
Author contributions: All authors contributed to the review article conception and design; identification, acquisition, and interpretation of the published medical literature; drafting and revising the manuscript; and the approval of the final version of the manuscript for submission.
Conflict-of-interest statement: F Paul Buckley acts as an advisor to Ethicon and has received funding for surgeon teaching and consulting on product development; Benjamin Havemann has received funding from Ethicon as a guest speaker; Amarpreet Chawla is a paid full-time employee of Ethicon Inc. There was no funding for the design and development of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: F Paul Buckley, MD, Associate Professor, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1601 Trinity St., Austin, TX 78712, United States. tripp.buckley@austin.utexas.edu
Telephone: +1-512-324-4373Fax: +1-512-495-5479
Received: February 21, 2019
Peer-review started: February 22, 2019
First decision: May 9, 2019
Revised: June 13, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: August 16, 2019
Processing time: 176 Days and 19.8 Hours
Abstract

Outcomes associated with magnetic sphincter augmentation (MSA) in patients with gastroesophageal reflux disease (GERD) have been reported, however the optimal population for MSA and the related patient care pathways have not been summarized. This Minireview presents evidence that describes the optimal patient population for MSA, delineates diagnostics to identify these patients, and outlines opportunities for improving GERD patient care pathways. Relevant publications from MEDLINE/EMBASE and guidelines were identified from 2000-2018. Clinical experts contextualized the evidence based on clinical experience. The optimal MSA population may be the 2.2-2.4% of GERD patients who, despite optimal medical management, continue experiencing symptoms of heartburn and/or uncontrolled regurgitation, have abnormal pH, and have intact esophageal function as determined by high resolution manometry. Diagnostic work-ups include ambulatory pH monitoring, high-resolution manometry, barium swallow, and esophagogastroduodenoscopy. GERD patients may present with a range of typical or atypical symptoms. In addition to primary care providers (PCPs) and gastroenterologists (GIs), other specialties involved may include otolaryngologists, allergists, pulmonologists, among others. Objective diagnostic testing is required to ascertain surgical necessity for GERD. Current referral pathways for GERD management are suboptimal. Opportunities exist for enabling patients, PCPs, GIs, and surgeons to act as a team in developing evidence-based optimal care plans.

Keywords: Gastroesophageal reflux disease; Surgery; Magnetic sphincter augmentation; Referral pathways

Core Tip: While the outcomes associated with magnetic sphincter augmentation (MSA) in patients with gastroesophageal reflux disease (GERD) have been previously reported, the optimal population for MSA and the related patient care pathways have not been summarized. This review presents evidence that describes the optimal patient population for MSA, delineates diagnostics to identify these patients, and outlines opportunities for improving GERD patient care pathways. Current referral pathways for GERD management are suboptimal. Opportunities exist for enabling patients, primary care providers, gastroenterologists, and surgeons to act as a team in developing evidence-based optimal care plans.