Brigham Offering Magnetic Sphincter Augmentation for Patients With GERD

LINX product shown banded around a diagram of the lower esophageal sphincter above stomach

Patients seeking surgical treatment for gastroesophageal reflux disease (GERD) have several options at their disposal through Brigham and Women’s Hospital’s Division of General and Gastrointestinal Surgery. The newest and most innovative is magnetic sphincter augmentation using the LINX® Reflux Management System. This minimally invasive procedure is indicated for patients who have GERD without hernia and want an alternative to acid suppression therapy with proton pump inhibitors or traditional surgical treatment.

Two Brigham surgeons offering the procedure are Thomas C. Tsai, MD, MPH, a minimally invasive gastrointestinal and bariatric surgeon and director of clinical care redesign in the Department of Surgery, and David Spector, MD, director of bariatric and anti-reflux surgery at Brigham and Women’s Faulkner Hospital. (The White House recently named Dr. Tsai senior policy advisor for the COVID-19 Response; he will be taking a sabbatical from the Brigham to serve in this new role.)

Dr. Tsai notes that for a subset of patients with severe acid reflex, the data surrounding LINX show favorable short- and long-term outcomes. “Our goals when discussing surgical options with patients who have severe and debilitating heartburn is to improve their symptoms, reduce their reliance on proton pump inhibitors and other medications, and restore their quality of life,” he says. “The LINX system affords the additional benefit of quicker recovery, allowing patients to get back to eating regular food almost immediately.”

Restoring Sphincter Function

The goal of LINX is to augment a weak lower esophageal sphincter to restore sphincter function without compressing the esophagus.

The LINX device—about the size of a quarter—consists of a series of titanium beads with magnetic cores that are connected with independent titanium wires. During swallowing, the beads slide away from each other on the wires to allow food passage. Then, the beads contract back into place, increasing the pressure at the gastroesophageal junction to prevent gastric acid from flowing up into the esophagus.

Fundoplication, the most common surgical treatment option for GERD, requires patients to adhere to a liquid diet for up to three weeks after surgery. In contrast, patients receiving LINX “can eat regular food that’s soft to chew” right away, according to Dr. Tsai. This strategy allows the device to exercise its expansion and contraction soon after surgery, preventing it from scarring in.

“In fact, the first patient on whom I conducted the surgery was delighted to be walking and eating a chicken parmesan sandwich just a few hours after surgery without experiencing any heartburn,” Dr. Tsai says.

He adds that while LINX is not a replacement for fundoplication, it does provide surgeons at the Brigham with an option that is more reproducible and durable, with less risk of side effects. It also minimizes gas bloat and trouble swallowing associated with fundoplication wraps. He says patients can benefit equally from both types of procedures.

“Outcomes are similar for patients with proven acid reflux who don’t have a severe swallowing disorder of the esophagus, in terms of reducing reflux and reliance on medications,” Dr. Tsai says. “My goal as a surgeon is to counsel my patients on the risks and benefits of every option and align those options with their treatment goals to tailor the treatment that’s right for them.”

“A hallmark of our multidisciplinary anti-reflux program is offering all effective surgical options, including magnetic sphincter augmentation as a primary treatment for patients with reflux,” Dr. Spector adds.

Onboarding the New Surgical Procedure

Drs. Tsai and Spector monitored LINX industry trials and hundreds of cases conducted at institutions around the globe for a decade to evaluate the system and determine whether it would be a beneficial option for patients. They worked closely with surgical colleagues to discuss the innovative system and review all the data before seeking approval through the relevant Brigham surgical and perioperative committees. Once it was approved, the entire surgical team participated in training sessions.

“Onboarding a new surgical procedure like this one involves more than just the surgeon,” Dr. Spector says. “We needed to make sure the entire OR and clinical team, including nurses, surgical technologists, anesthesiologists, dietitians, physician assistants, and residents were all aware of the process and procedures required.”

Feedback from patients has been positive to date, according to Dr. Tsai. “We have recently started seeing patients come to the Brigham specifically seeking this treatment, which is a great testament to our reputation as a center for surgical innovation that enhances the care of our patients,” he says.

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