Clinical efficacy and safety of magnetic sphincter augmentation (MSA) and transoral incisionless fundoplication (TIF2) in refractory gastroesophageal reflux disease (GERD): A systematic review and meta-analysis

Background and study aims  Proton pump inhibitors (PPI) are effective medical therapy options for gastro-esophageal reflux disease (GERD). However, 20% to 40% of patients report symptoms despite taking daily PPI. Transoral incisionless fundoplication (TIF2) and magnetic sphincter augmentation (MSA) are less invasive options for the treatment of refractory GERD and are increasingly gaining popularity. Methods  We conducted a comprehensive search of several databases to identify relevant studies. Our primary aim was to compare the efficacy of both interventions reported as improvement in Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) score, overall patient satisfaction, improvement in post-procedure regurgitation, and fraction of patients completely off PPI therapy at follow up. Results  Twenty-four studies with 1942 patients were included in the final analysis. Both MSA and TIF2 had comparable technical success and clinical success based on improvement in GERD-HRQL scores i.e. 98.8% (CI 95.6,99.7) vs 98.5% (CI 95.7,99.5) and 80.4% (CI 66,89.6) vs 77.7% (CI 64.1,87.2), respectively. A significantly greater proportion of patients reported improvement in regurgitation, i.e. 91.1% (CI 83.8,95.3) vs 73.1% (CI 62.5,81.7) and were able to completely discontinue PPI therapy with MSA compared to TIF2 i.e. 91.3% (CI 81.5,96.2) vs 63.8% (CI 51.6,74.4). Patients' BMI and presence of a hiatal hernia did not have any effect on procedural outcomes. Conclusion  Both procedures performed at par when comparing clinical success in terms of improvement in GERD-HRQL scores. In terms of overall patient satisfaction, post procedure regurgitation and cumulative number of patients off PPI therapy, MSA outperforms TIF2.