More than a mechanical problem: Dysphagia and new-onset ineffective esophageal motility after LINX® placement-a case...

Magnetic sphincter augmentation (MSA) with the LINX® device is an effective surgical option for gastroesophageal reflux disease (GERD), offering benefits such as preservation of belching and reduced gas bloat syndrome compared to Nissen fundoplication. However, postoperative dysphagia is common complication, occurring in approximately 15-30 % of patients.

We report the case of a 66-year-old female who underwent laparoscopic hiatal hernia repair with concurrent LINX® device placement for GERD. Three weeks postoperatively, she developed progressive dysphagia that was initially responsive to corticosteroids but recurred. Barium swallow demonstrated mild narrowing at the gastroesophageal junction. Despite three serial endoscopic dilations, her symptoms persisted. High-resolution manometry (HRM) revealed new-onset ineffective esophageal motility (IEM), in contrast to her preoperative study, which showed normal esophageal peristalsis. The LINX device was surgically removed due to refractory symptoms. Post-removal, the patient experienced significant symptomatic improvement. Repeat HRM one year later showed improved motility findings.

This case illustrates the potential for MSA to contribute to the development of esophageal dysmotility in patients with subtle or predisposing motility abnormalities. Early postoperative dysphagia should prompt repeat manometric evaluation and consideration of device removal in refractory cases.

MSA may lead to de novo IEM. Thorough preoperative evaluation and timely reassessment of postoperative symptoms are key to optimizing patient outcomes.