Magnetic Sphincter Augmentation for Gastroesophageal Reflux Following Sleeve Gastrectomy: A Scoping Review and First Asian Case Series

INTRODUCTION: Magnetic Sphincter Augmentation (MSA) has emerged as a possible surgical option in patients with gastroesophageal reflux following sleeve gastrectomy (SG). The published literature primarily originates from Western populations, with no reported cases outside the U.S. The purpose of this study was to review the current literature on the use of MSA for treating gastroesophageal reflux after SG and analyze our institution's experience. METHODS: A literature search of PubMed, EMBASE, Cochrane, and Scopus was conducted from inception to 3 May 2025 to identify studies describing the use of MSA for gastroesophageal reflux following SG. Additionally, all consecutive patients who underwent MSA implantation for gastroesophageal reflux following SG between June 2019 and December 2023 were identified from our institution's database. RESULTS: The scoping review identified eight studies from the U.S., reporting on 108 patients. More than half of these patients no longer required daily PPI use after MSA implantation. Compared to pre-MSA GERD-HRQL scores, which ranged from 17.1 to 46.0, post-MSA scores were lower, ranging from 4.1 to 19.0. This first Asian case series included seven patients and found that, following MSA implantation, six out of seven continued to report daily proton pump inhibitor (PPI) use. The mean pre-MSA Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) score was 44.4, and the mean modified DeMeester symptom score was 4.1. These improved to 31.4 (p = 0.06) and 3.0 (p = 0.27), respectively, post-MSA. No MSA-related adverse events were recorded. CONCLUSION: While the scoping review suggested that MSA may lead to symptomatic improvement in selected patients with gastroesophageal reflux following SG, this is based on low-level evidence. Our case series showed that only modest symptom improvements were observed following MSA for the treatment of reflux after SG in the Asian population.