Do new technologies play a role in the management of reflux after bariatric surgery?

Clinical Case

Best management of reflux after bariatric surgery is an ongoing debate, and literature on the topic is limited. Up to 60% of bariatric patients present with gastroesophageal reflux disease (GERD) and approximately 20% will develop de novo GERD after bariatric surgery, particularly after sleeve gastrectomy. In this debate, three experts discuss the best management of reflux after bariatric surgery during IFSO 2017, held in London.

Dr. Reddy presents the Linx® anti-reflux management system, a magnetic sphincter augmentation device. The system is constituted by a small flexible band of interlinked titanium beads with magnetic cores, intended to help the low esophageal sphincter resist opening to gastric pressures, preventing reflux from the stomach into the esophagus. Its indications, technique, complications, and results are presented, as well as a unique video of the removal of a Linx® device due to esophageal spasms.

Dr. Mattar presents the endoscopic radiofrequency treatment for reflux after bariatric surgery. This non-ablative radiofrequency treatment (Stretta® ) based on heat-induced collagen contraction does not require reversal or surgery, and has minimal adverse events. Over 20,000 procedures have been performed, with favorable results and minimal complications. For these reasons it is proposed as an adequate solution halfway between medical and surgical treatment for patients suffering from reflux after bariatric surgery.

Finally, Dr. Higa proposes revisional surgery as the answer to reflux after bariatric surgery, supported by a thorough review of the literature. The lack of correlation between symptoms and de novo-reflux mandates a strict post-operative follow-up for patients, who ultimately benefit from revisional surgery as the best option to treat reflux after bariatric surgery.