ArticleSurgical endoscopy2026
Large-caliber endoscopic balloon dilation in patients with persistent dysphagia after magnetic sphincter augmentation (MSA) is safe and may reduce the need for subsequent dilations and device removal.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsDysphagia is the most frequent adverse event after magnetic sphincter augmentation (MSA). The package insert recommends post-MSA dilation at 15 mm, but it is unclear whether MSA size and index dilation diameter affect clinical outcomes. We analyzed retrospective data over 10 years to identify predictors of post-MSA dysphagia and compared the index 30 mm dilation (over the wire under fluoroscopic guidance) strategy vs. conventional (< 20 mm dilation) through the scope (TTS).
methodsDemographics, MSA size, and postoperative endoscopic dilations were recorded for adults undergoing MSA for refractory GERD at a single tertiary center (Jan 2014-Jan 2025). Multivariable logistic regression identified independent risk factors for dilation. Outcomes after index 30 mm dilation were compared with index < 20 mm TTS dilations. PRIMARY ENDPOINTS: repeat dilation (> = 1 additional dilation), device explantation. Secondary endpoints: complications.
resultsOf 304 MSA recipients (63% female, mean age 57 ± 14 y), 74 (24.3%) developed dysphagia requiring endoscopic dilation. Older age increased this risk (OR 1.16 per 5 y; 95% CI 1.03-1.29; p = 0.01), each increment in size of MSA reduced it (OR 0.73; 95% CI 0.56-0.98; p = 0.03). 44 patients underwent < 20 mm dilation and 30 underwent 30 mm dilation. Repeat dilation was required in 20/44 (45.5%) vs. 9/30 (20%) respectively; ARR 25.5%, NNT = 4. Initial 30 mm dilation lowered the repeat-dilation risk (OR 0.24; 95% CI 0.07-0.91; p = 0.03). Device explantation was seen in 15 patients (4.9%), only three had received a 30 mm dilation. No perforations, erosions, or procedure-related hospitalizations were seen.
conclusionIn this 10-year retrospective cohort, larger MSA size was significantly associated with lower post-MSA dysphagia, and treating dysphagia with initial 30 mm dilation reduced the repeat-procedure rate by 76% relative to small-caliber dilation without added morbidity. Prospective multicenter data from physiologic manometric studies are needed to refine protocols for endoscopic therapy in post-MSA dysphagia.
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