GERD affects approximately 25% of US adults and is commonly treated with PPIs or laparoscopic fundoplication.
MSA is FDA-approved since 2012 and offers comparable reflux control with fewer side effects like gas bloat compared to fundoplication.
Postoperative dysphagia occurs in 43–83% of MSA patients, often resolving by 8 weeks but sometimes requiring intervention.
Guideline-Based Recommendations
Diagnosis
Confirm GERD diagnosis with objective testing: esophageal pH or impedance-pH monitoring after PPI cessation for 10 days.
Perform esophagogastroduodenoscopy (EGD) with biopsy to assess esophagitis, Barrett’s esophagus, and hiatal hernia.
Use high-resolution impedance manometry (HRIM) to evaluate esophageal motility and sphincter pressures.
Management
Consider MSA for patients with persistent GERD symptoms despite maximal medical therapy and objective reflux evidence.
Monitor for postoperative dysphagia; most cases resolve within 8 weeks.
For persistent dysphagia, consider endoscopic dilation or device removal as needed.
Monitoring & Follow-up
Assess symptom severity and patient satisfaction pre- and postoperatively using GERD-HRQL questionnaire.
Follow patients closely for dysphagia symptoms post-MSA, especially within the first 8 weeks.
Repeat objective testing as clinically indicated to evaluate reflux control and esophageal function.
Risks
Postoperative dysphagia is the most common complication after MSA, occurring in up to 83% of patients early post-op.
Long-term PPI use carries risks including infectious diarrhea, osteoporosis, and drug interactions.
Laparoscopic fundoplication side effects include gas bloat, inability to belch or vomit, and anatomic failure.
Patient & Prescribing Data
Adults with symptomatic GERD refractory to medical therapy and confirmed reflux on objective testing
MSA provides effective reflux control with reduced side effects compared to fundoplication; however, clinicians should counsel patients on the high incidence of early postoperative dysphagia and its typical resolution.
Clinical Best Practices
Perform comprehensive preoperative evaluation including symptom assessment, GERD-HRQL scoring, EGD, HRIM, and pH monitoring.
Discontinue PPIs 10 days prior to pH testing to ensure accurate reflux measurement.
Select patients carefully excluding those with prior foregut surgery, significant esophageal dysmotility, or titanium allergy.
Educate patients about the likelihood of early postoperative dysphagia and the expected natural course.
Implement a stepwise approach to persistent dysphagia including conservative management, endoscopic dilation, and device removal if necessary.
by Shahin Ayazi, Ping Zheng, Ali H. Zaidi, Kristy Chovanec, Nobel Chowdhury, Madison Salvitti, Yoshihiro Komatsu, Ashten N. Omstead, Toshitaka Hoppo, Blair A. Jobe
