On September 24, 2012, David B. Adams, M.D., Co-Medical Director of MUSC’s Digestive Disease Center, implanted the LINX Reflux Management System (Torax Medical, Minneapolis-St. Paul, MN), a device for managing medication-resistant gastroesophageal reflux disease (GERD), in two patients. MUSC is one of fewer than 20 centers in the country and one of only three in the Southeast chosen by the device’s manufacturer to roll out LINX, which was approved as a safe and effective treatment for medication-resistant GERD in March of 2012. MUSC was chosen in part because of the reputation, clinical expertise and leadership of Donald O. Castell, M.D., Director of the Esophageal Disorders Program, in treating GERD and of the top-flight program he has built at MUSC.
The device consists of a “necklace” of magnetized titanium beads that can be placed around the lower esophageal sphincter to provide better closure and to prevent reflux of food or bile from the stomach into the esophagus (right). The device is inserted laparoscopically, meaning that five ¼-inch slits are cut into the abdomen through which a telescope is inserted; the images recorded by the telescope can then be seen on a television monitor. Surgeons use sutures on the device to position it into place (below). The procedure typically takes less than an hour.
Once in place, the device prevents or minimizes reflux, leading to a less acidic environment in the esophagus and to fewer of the hallmark symptoms of GERD (recurring heartburn, regurgitation, difficulty lying flat).
The dynamic device is “beautifully engineered,” according to Dr. Adams, in that the “necklace” of magnets tightens when the esophagus is at rest but loosens to allow passage of food when food is swallowed (below, right). Its dynamic nature helps ensure its durability. It is not likely to erode into the stomach (a problem with an earlier plastic prosthesis called the Angelchick) because the tension of the necklace is continually adjusting to the pressure placed on the esophagus (ie, by swallowing); a collagen sheath that naturally develops around it renders it almost biologic and helps protect against damage to any surrounding tissue.
Side effects with the LINX device are less severe and less frequent than with the most widely used treatment for medication-resistant GERD, Nissen fundoplication, a procedure in which the top of the stomach is essentially tied around the bottom part of the esophagus to improve closure. Instead of the typical one- to two- day hospitalization after Nissen fundoplication, patients implanted with a LINX device can typically go home the same day because they have less pronounced symptoms (ie, less trouble swallowing and less pain). Also, unlike the Nissen fundoplication, which cannot be reversed, the LINX device can be removed should the need arise.
The LINX device is not currently recommended for patients with large hiatal hernias (>3cm), a BMI greater than 35, a history of trouble swallowing, or Barrett’s esophagus (a sometimes precancerous condition characterized by a damaged lining to the esophagus). Patients should exhaust nonsurgical treatments for GERD before considering LINX.
Once implanted with the titanium-bead implant, patients should avoid magnetic resonance imaging (MRI) because the beads could cause it to malfunction and cause harm.
For more information on LINX, contact Mary E. Johnson, RN at 843-876-3090.
To view a video demonstrating the design of the LINX device, click here.