Related Experiment Video
Updated: Jan 21, 2026
Usability Evaluation of Augmented Reality: A Neuro-Information-Systems Study
Published on: November 30, 2022
Magnetic Sphincter Augmentation and Postoperative Dysphagia: Characterization, Clinical Risk Factors, and Management
Shahin Ayazi1, Ping Zheng1, Ali H Zaidi1
1Esophageal and Lung Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA.
Introduction:
Magnetic sphincter augmentation (MSA) results in less severe side effects compared with Nissen fundoplication, but dysphagia remains the most common side effect reported by patients after MSA. This study aimed to characterize and review the management of postoperative dysphagia and identify the preoperative factors that predict persistent dysphagia after MSA.
Material And Methods:
This is a retrospective review of prospectively collected data of patients who underwent MSA between 2013 and 2018. Preoperative objective evaluation included upper endoscopy, esophagram, high-resolution impedance manometry (HRIM), and esophageal pH testing. Postoperative persistent dysphagia was defined as a postoperative score of > 3 for the dysphagia-specific item within the GERD-HRQL at a minimum of 3 months following MSA. A timeline of dysphagia and dilation rates was constructed and correlated with the evolution of our patient management practices and modifications in surgical technique.
Results:
A total of 380 patients underwent MSA, at a mean (SD) follow up of 11.5 (8.7) months, 59 (15.5%) patients were experiencing persistent dysphagia. Thirty-one percent of patients required at least one dilation for dysphagia or chest pain and the overall response rate to this procedure was 67%, 7 (1.8%) patients required device removal specifically for dysphagia. Independent predictors of persistent dysphagia based on logistic regression model included (1) absence of a large hernia (OR 2.86 (95% CI 1.08-7.57, p = 0.035)); (2) the presence of preoperative dysphagia (OR 2.19 (95% CI 1.05-4.58, p = 0.037)); and (3) having less than 80% peristaltic contractions on HRIM (OR 2.50 (95% CI 1.09-5.73, p = 0.031)). Graded cutoffs of distal contractile integral (DCI), mean wave amplitude, DeMeester score, sex, and body mass index were evaluated within the model and did not predict postoperative dysphagia. Frequent eating after surgery, avoidance of early dilation, and increase in the size of the LINX device selected decreased the need for dilation.
Conclusion:
In a large cohort of patients who underwent MSA, we report 15.5% rate of persistent postoperative dysphagia. The overall response rate to dilation therapy is 67%, and the efficacy of dilation with each subsequent procedure reduces. Patients with normal hiatal anatomy, significant preoperative dysphagia, and less than 80% peristaltic contractions of the smooth muscle portion of the esophagus should be counseled that they have an increased risk for persistent postoperative dysphagia.
Insights
Magnetic sphincter augmentation (MSA) can cause dysphagia in 15.5% of patients. Preoperative dysphagia, normal hiatal anatomy, and poor esophageal peristalsis predict persistent symptoms. Dilation therapy is effective in 67% of cases.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Esophageal Motility Disorders
Background:
- Magnetic sphincter augmentation (MSA) is an alternative to Nissen fundoplication for GERD.
- While MSA has fewer side effects, dysphagia remains a common postoperative complication.
- Understanding predictors of dysphagia is crucial for patient selection and management.
Purpose of the Study:
- To characterize the incidence and management of dysphagia after MSA.
- To identify preoperative factors predicting persistent dysphagia post-MSA.
- To evaluate the efficacy of dilation therapy for postoperative dysphagia.
Main Methods:
- Retrospective review of 380 patients undergoing MSA (2013-2018).
- Preoperative assessments included endoscopy, esophagram, high-resolution impedance manometry (HRIM), and pH testing.
- Persistent dysphagia defined as GERD-HRQL dysphagia score >3 at 3 months post-MSA.
Main Results:
- 15.5% of patients experienced persistent dysphagia.
- Predictors of dysphagia included absence of large hiatal hernia, preoperative dysphagia, and <80% peristaltic contractions on HRIM.
- Dilation therapy was required by 31%, with a 67% response rate; 1.8% required device removal.
Conclusions:
- Persistent dysphagia affects 15.5% of patients post-MSA.
- Dilation therapy efficacy decreases with repeated procedures.
- Patients with specific preoperative factors require counseling regarding increased dysphagia risk.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:21Barrett Esophagus-II: Clinical Manifestations and Management
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...