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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(04): E583-E598
DOI: 10.1055/a-1352-2944
Review

Clinical efficacy and safety of magnetic sphincter augmentation (MSA) and transoral incisionless fundoplication (TIF2) in refractory gastroesophageal reflux disease (GERD): a systematic review and meta-analysis

Saurabh Chandan‡
 1   Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
,
Babu P. Mohan‡
 2   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Shahab R. Khan
 3   Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Lokesh K. Jha
 4   Gastroenterology, Parkview Health, Fort Wayne, Indianapolis, United States
,
Amaninder J. Dhaliwal
 1   Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
,
Mohammad Bilal
 5   Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
,
Muhammad Aziz
 6   Internal Medicine, University of Toledo, Toledo, Ohio, United States
,
Andrew Canakis
 7   Internal Medicine, Boston University Medical Center, Boston, Massachusetts, United States
,
Sumant Arora
 8   Gastroenterology & Hepatology, University of Iowa, Iowa City, Iowa, United States
,
Sarah Malik
 1   Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
,
Lena L. Kassab
 9   Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Suresh Ponnada
10   Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, United States
,
Ishfaq Bhat
 1   Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
,
Alexander T. Hewlett
 1   Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
,
Neil Sharma
 5   Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
,
Stephanie McDonough
 2   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Douglas G. Adler
 2   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Abstract

Background and study aims Proton pump inhibitors (PPI) are effective medical therapy options for gastro-esophageal reflux disease (GERD). However, 20 % to 40 % of patients report symptoms despite taking daily PPI. Transoral incisionless fundoplication (TIF2) and magnetic sphincter augmentation (MSA) are less invasive options for the treatment of refractory GERD and are increasingly gaining popularity.

Methods We conducted a comprehensive search of several databases to identify relevant studies. Our primary aim was to compare the efficacy of both interventions reported as improvement in Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) score, overall patient satisfaction, improvement in post-procedure regurgitation, and fraction of patients completely off PPI therapy at follow up.

Results Twenty-four studies with 1942 patients were included in the final analysis. Both MSA and TIF2 had comparable technical success and clinical success based on improvement in GERD-HRQL scores i. e. 98.8 % (CI 95.6,99.7) vs 98.5 % (CI 95.7,99.5) and 80.4 % (CI 66,89.6) vs 77.7 % (CI 64.1,87.2), respectively. A significantly greater proportion of patients reported improvement in regurgitation, i. e. 91.1 % (CI 83.8,95.3) vs 73.1 % (CI 62.5,81.7) and were able to completely discontinue PPI therapy with MSA compared to TIF2 i. e. 91.3 % (CI 81.5,96.2) vs 63.8 % (CI 51.6,74.4). Patients’ BMI and presence of a hiatal hernia did not have any effect on procedural outcomes.

Conclusion Both procedures performed at par when comparing clinical success in terms of improvement in GERD-HRQL scores. In terms of overall patient satisfaction, post procedure regurgitation and cumulative number of patients off PPI therapy, MSA outperforms TIF2.

Supplementary material



Publication History

Received: 21 July 2020

Accepted: 09 December 2020

Article published online:
13 April 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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