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Magnetic sphincter augmentation erosion affects nearly 4% of patients after sleeve gastrectomy, with obesity, inadequate hiatal repair, and device undersizing significantly increasing risk.
Magnetic sphincter augmentation (MSA), a less invasive alternative to Roux-en-Y gastric bypass for managing gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG), is associated with a higher-than-expected risk of device erosion, according to a new systematic review and meta-analysis.
Pooling data from 14 studies and 287 patients, investigators found that 3.8% of patients (11/287) developed MSA device erosion after sleeve gastrectomy—a rate more than tenfold higher than the 0.1%–0.3% reported in non-bariatric populations (P < 0.001). Patients were followed for a median of 24 months, and erosions typically occurred 18 months after implantation. The analysis also pinpointed numerous factors that substantially increased erosion risk. A body-mass index (BMI) greater than 30 kg/m² at the time of MSA implantation was linked with a more than 3-fold increase in risk (odds ratio [OR] 3.2).
Technical factors appeared equally important: absence of hiatal repair (OR, 4.1) and device undersizing (OR, 3.8) were among the strongest predictors of erosion. In addition, persistent sleeve dilatation escalated risk by nearly threefold (OR, 2.7). For most patients, erosion did not remain silent. Nearly three-quarters (72.7%) presented with dysphagia, making swallowing difficulty the most common warning sign. Once erosion occurred, device removal was required in every case. Encouragingly, outcomes after explantation were favorable, with 90.9% of patients reporting symptom resolution following device removal.
While the findings highlight a clearly elevated erosion risk after sleeve gastrectomy, the authors noted that the overall incidence remains relatively low and should be considered alongside the 7%–8% complication rate associated with conversion to Roux-en-Y gastric bypass. The results suggest that careful patient selection and attention to modifiable factors—including weight optimization, meticulous hiatal repair, appropriate device sizing, and evaluation of sleeve anatomy—may help minimize erosion risk and enhance long-term outcomes. As the use of MSA continues to expand in post-bariatric patients, these findings provide important guidance for surgeons seeking to balance reflux control with procedural safety.
Surgery for Obesity and Related Diseases
Risk of magnetic sphincter augmentation erosion following sleeve gastrectomy: a systematic review and meta-analysis
Patrick Noel et al.
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