Magnetic Interventions for Gastroesophageal Reflux

Gastroesophageal reflux with or without hiatal hernia is a very prevalent disease that affects up to 30% of the population in western countries. Magnetic sphincter augmentation (Linx ™) is an innovative laparoscopic procedure for gastroesophageal reflux disease that provides a more standardized surgical option for patients dissatisfied with medical therapy and for those with early-stage disease who would not usually be considered ideal candidates for fundoplication. The Linx is a mechanical device manufactured in different sizes and designed to augment the physiologic barrier to reflux by magnetic force. The device consists of a series of titanium beads containing a magnetic core and interlinked with independent titanium wires to form an expandable ring. Magnetic sphincter augmentation is highly effective in reducing typical reflux symptoms and use of proton-pump inhibitors, decreasing esophageal acid exposure, and improving patients’ quality of life. Safety issues such as device erosions or migrations have been rare and not associated with mortality. The device can be easily removed laparoscopically, if necessary, thereby preserving the option of fundoplication or other therapies in the future. Potential limitations of the Linx procedure are the untested efficacy in the presence of large hiatal hernia and Barrett’s esophagus and the contraindication to undergo scanning in >1.5 Tesla magnetic resonance systems.