Systematic Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2020; 8(2): 294-305
Published online Jan 26, 2020. 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
Dimitrios Schizas, Aikaterini Mastoraki, Eleni Papoutsi, Vassilis G Giannakoulis, Prodromos Kanavidis, Diamantis Tsilimigras, Dimitrios Ntourakis, Orestis Lyros, Theodore Liakakos, Dimitrios Moris
Dimitrios Schizas, Eleni Papoutsi, Vassilis G Giannakoulis, Prodromos Kanavidis, Theodore Liakakos, 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens 11527, Greece
Aikaterini Mastoraki, 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 11527, Greece
Diamantis Tsilimigras, 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
Dimitrios Ntourakis, Department of Surgery, School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
Orestis Lyros, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig 04103, Germany
Dimitrios Moris, Department of Surgery, Duke University Medical Center, Duke University, Durham, NC 27705, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
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: Dimitrios Moris, MD, MSc, PhD, Academic Fellow, Academic Research, Doctor, Research Fellow, Surgeon, Department of Surgery, Duke University Medical Center, Duke University, 2310 Erwin Road, Durham, NC 27705, United States. dimmoris@yahoo.com
Received: November 12, 2019
Peer-review started: November 12, 2019
First decision: November 19, 2019
Revised: December 6, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: January 26, 2020
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: LINX® reflux management system, Magnetic sphincter augmentation, Gastroesophageal reflux disease, Gastroesophageal reflux disease - health - related quality of life

Core tip: Gastroesophageal reflux disease 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. The findings of our review enforce the notion 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.