Linx sytem for GERD – pro
The Linx Reflux Management System (Torax Medical, Shoreview, Minn.) is a relatively new minimally invasive laparoscopic surgery option for medically refractory GERD. It is a sphincter augmentation device consisting of a series of magnetic titanium beads connected on a stainless-steel cable. The device is intended to reduce the esophagus’s exposure to acid, improve symptoms, and reduce or eliminate the need for GERD medications. The beads are used to encircle the LES to reinforce the barrier, and magnetic attraction between the beads is intended to close the LES except when needed to allow swallowing of food and liquid.
The evidence base for this technology consists of two prospective case series sponsored by the manufacturer and reporting on 144 patients (Ganz et al. 2013; Lipham et al. 2012). Interpretation of results is difficult because of deficiencies in the comparisons made, reporting of results, patient loss to follow-up, and post hoc analyses after one-year follow-up. However, there are supporting guidelines:
In 2013, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) published a Technology
and Value Assessment guideline on the safety and effectiveness of the LINX™ Reflux Management System.
SAGES Technology and Value Assessment Committee stated that safety analyses of the LINX™ system
suggests the procedure is associated with few serious adverse events and no reported mortality, and that
currently available data demonstrates a reasonable assurance as to the efficacy of the LINX® Reflux
Management System. The committee concluded that direct comparative studies between the LINX™ procedure
and Nissen fundoplication will be needed, although, based on the available evidence, the LINX™ device should
be an option available to patients and providers for the management of medically refractory GERD.
American Society for Gastrointestinal Endoscopy
A 2013 report on emerging technology from the American Society for Gastrointestinal Endoscopy (ASGE)
concluded that long-term data about the safety and efficacy of the LINX™ device are needed. The document
indicates that the LINX™ band is currently being deployed laparoscopically; however, a natural orifice
transluminal endoscopic surgery approach could be explored.
American Society of General Surgeons
In 2014, the American Society of General Surgeons (ASGS) published a position statement in support of the LINX
procedure. The ASGS recommends comprehensive management of GERD with use of medical and surgical
interventions that provide safe control with minimal side effects. The society states:
“Based on currently available information and the experience of their members with the procedure, they
support the LINX procedure as a mechanism for controlling GERD when it is placed by properly trained
laparoscopic surgeons with experience in foregut surgery and the management of GERD patients.”
1. Reynolds JL, Zehetner J, Wu P, et al. Laparoscopic Magnetic Sphincter Augmentation vs Laparoscopic
Nissen Fundoplication: A Matched-Pair Analysis of 100 Patients. J Am Coll Surg. Jul 2015;221(1):123-
128. PMID 26095560
2. Louie BE, Farivar AS, Shultz D, et al. Short-Term Outcomes Using Magnetic Sphincter Augmentation
Versus Nissen Fundoplication for Medically Resistant Gastroesophageal Reflux Disease. Ann Thorac
Surg. Aug 2014;98(2):498-504. PMID 24961840
3. Sheu EG, Nau P, Nath B, et al. A comparative trial of laparoscopic magnetic sphincter augmentation and
Nissen fundoplication. Surg Endosc. Mar 2015;29(3):505-9. PMID 25012804
4. Riegler M, Schoppman SF, Bonavina L, et al. Magnetic sphincter augmentation and fundoplication for
GERD in clinical practice: one-year results of a multicenter, prospective observational study. Surg
Endosc. May 2015;29(5):1123-1129.
Guidelines:
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). TAVAC Safety and
Effectiveness Analysis: LINX® Reflux Management System. 2013;
http://www.sages.org/publications/guidelines/tavac-safety-and-effectiveness-analysis-linx-refluxmanagement-
system/. Accessed November 2016.
ASGE Technology Committee. Magnets in the GI tract. Gastrointest Endosc. Oct 2013;78(4):561-567.
PMID 24054738
American Society of General Surgeons (ASGS). LINX statement of support from ASGS. 2014.
https://theasgs.org/position-statements/linx-statement-of-support-from-asgs