PTH-120 the linx reflux management system: predictive value of pre-operative oesophageal physiology testing on post-operative outcomes

Introduction The LINX reflux management device (Torax Medical) augments lower oesophageal sphincter function via implantation of magnetic beads around the gastro-oesophageal junction. There are specific instructions for use which require oesophageal physiology testing to ensure patients are suitable for surgery. Whilst these parameters mainly focus on peristaltic amplitudes being sufficient to open the beads, the predictive value of physiological parameters on symptom outcomes are uncertain. We therefore retrospectively assessed this relationship in the UK’s largest cohort of single surgeon cases. Methods A LINX device was implanted laparoscopically into 69 patients (40 male, mean age 49.5). Symptoms were assessed prior to and 6 months following surgery using a combined Gastroesophageal Reflux Disease Health Related Quality of Life score and Reflux Symptom Index score. Potential patients underwent high resolution impedance manometry and 24 hour pH/impedance monitoring prior to surgery. Patients with a major motility disorder were contra-indicated for surgery. Overall symptom improvement was tracked, and individual physiological parameters were assessed for ability to significantly improve outcome. Results There were no cases of LINX explant from the studied cohort. Data were assessed with Wilcoxon signed-rank and Mann-Whitney U tests. The combined symptom score improved from a mean of 43.77 to 11.86 (p Conclusion We summarise that using a pre-operative protocol where patients undergo oesophageal physiology tests allows for good patient selection and ensures excellent outcomes with significant improvement in symptoms post-operatively. In the absence of a major motility abnormality, those patients with weak motility, low MDA, or reduced IBC, do not experience significantly worse symptoms post-operatively. Those with reflux symptom correlation but where increased exposure was not noted on 24 hour monitoring may still benefit from the LINX