Background

Roux-en-Y gastric bypass is a common treatment option for refractory gastroesophageal reflux disease (GERD), particularly in patients with obesity. However, there remains a subset of patients that continue to have reflux following gastric bypass despite no obvious technical problems, such as gastrojejunal anastomotic stricture or obstruction. The use of a magnetic sphincter augmentation (MSA) device has been described as safe and effective in the treatment of GERD. We present a series of 5 patients who have undergone MSA device placement for the treatment of refractory GERD following gastric bypass. All patients had endoscopic and/or pathologic evidence of esophagitis, and one patient had biopsy confirmed Barrett's esophagus. Patients ranged in age from 43 to 64 years (mean 49.6). Preoperative DeMeester scores ranged from 21.9 to 71.6 (mean 52.8). All patients underwent manometry and had no contraindication to proceeding with MSA device placement. At the time of MSA device placement each patient had a small hiatal hernia that was repaired without mesh. All of the patients had improvement or resolution of their reflux symptoms, with the majority able to discontinue their proton pump inhibitor. The only noted morbidity was a patient that required a single endoscopic balloon dilation 6 months postoperatively. In our patient population, placement of a MSA device was safe and effective in the treatment of refractory GERD following gastric bypass. The availability of an additional treatment option in these patients is important in improving quality of life and preventing progression to higher grade esophagitis or Barrett's esophagus.