Magnetic Sphincter Augmentation for Gastroesophageal Reflux Disease: Experience from a Single Center in the Middle East

Abstract

Background:

Magnetic sphincter augmentation (MSA) using the LINX device is a minimally invasive treatment for gastroesophageal reflux disease (GERD). With increasing rates of sleeve gastrectomy and associated postoperative GERD, evaluating MSA outcomes in both post-bariatric and de novo patients is clinically relevant. Data from the Middle East remain limited.

Methods:

This retrospective cohort study included 30 consecutive patients who underwent LINX placement for GERD at King Abdulaziz University Hospital between 2018 and 2024. Briefly, 20 patients (66.7%) had prior sleeve gastrectomy, while 10 patients (33.3%) were de novo cases. Primary outcomes were improvement in GERD–Health-Related Quality of Life (GERD-HRQL) scores and proton pump inhibitor (PPI) discontinuation. Secondary outcomes included perioperative complications and comparison between patient groups.

Results:

The mean age was 42.8 years, and the mean body mass index was 26.9 kg/m². Hiatal hernia was present in 76.7% of patients (23/30). The mean operative time was 65 minutes, with a median LINX size of 15 beads. Early postoperative dysphagia occurred in 23.3% (7/30), with 10% (3/30) requiring endoscopic dilation (two postsleeve and one de novo). One postsleeve patient (3.3%) required laparoscopic device removal for migration after failed dilation; removal was technically challenging but uncomplicated, with sustained GERD improvement, likely related to hiatal scarring. Mean GERD-HRQL scores improved from 27.2 to 7.1 (P < .001), with 76.7% achieving a ≥50% reduction. Complete PPI cessation occurred in 66.7% (20/30), and 86.7% (26/30) achieved at least a 50% dose reduction. Outcomes were comparable between postsleeve and de novo patients.

Conclusions:

MSA appears safe and effective for GERD management in this Middle Eastern cohort, with outcomes comparable to international reports. Similar results in postsleeve gastrectomy and de novo patients support broader applicability. This series provides valuable regional outcome data.