OGBN P33 The Missing LINX® - Reconstituting the Hill Valve

Abstract

Abstract Background Magnetic sphincter augmentation (MSA) with LINX® is an increasingly utilised procedure as an effective and safe alternative for fundoplication in the management of gastro oesophageal reflux disease (GORD). Our aim was to evaluate the post-operative LINX® endoscopic appearances in maintaining the competence of the Hills valve. Here we present a retrospective review of endoscopic assessment post insertion of LINX® Reflux Management System. Methods Patients who underwent magnetic sphincter augmentation with LINX® between December 2012 and December 2022 at a single district general hospital were recruited for a retrospective case analysis. Photographs taken at the time of endoscopy were assessed to evaluate the gastroesophageal flap valve using the Hill classification. Results Of 186 patients who underwent MSA, 40 underwent endoscopy post-operatively and of these 35 had photographs suitable for evaluation. There were various indications for endoscopy including dysphagia (13), dyspepsia (9), abdominal pain (7), laryngopharyngeal reflux (2), odynophagia (2), Barrett’s surveillance (1) and food bolus (1). Median time from LINX® to endoscopy was 2.5 years. 33 out of 35 patients (94.2%) were found to have Hills Grade I. One patient (2.8%) had Hills Grade II and one patient (2.8%) had a recurrence of their hiatus hernia, Hills Grade IV. Conclusions Endoscopy is a useful modality to assess symptomatic patients after MSA with LINX®. This study has confirmed reconstitution of the Hills valve on endoscopic assessment in 94.2% of patients. This supports LINX® as an effective and robust solution in the management of GORD.