LINX – A gentler, less invasive, but effective surgical anti-reflux procedure?

The LINX device (Torax Medical, Inc., Shoreview, MN, USA) consists of a miniature ring of connected titanium beads that contain a neodymium magnetic core. This miniature bracelet is placed by a laparoscopic surgeon around the gastroesophageal junction (where esophagus and stomach meet).

In the resting state the beads cling together thereby closing the esophagus and preventing acid reflux. When food comes down the esophagus it forces the miniature magnets apart until the food has passed. Belching and vomiting are possible, avoiding the problems that can occur with the traditional Nissen fundoplication. The surgeon can use standard laparoscopy equipment and only minimal dissection (cutting) is necessary.

Tiny magnetic beads act as an artificial sphincter preventing acid reflux.

How effective is LINX?

Current data show that 85 to 88 percent of patients are no longer on PPIs (proton pump inhibitors such as Prilosec or omeprazole), have significant improvement in their reflux symptoms and reduced acid exposure on testing at the 3 and 5-year mark. Many patients (about 70 %) initially report some trouble swallowing but this typically resolves after a few weeks. At 1 year 10 % report such symptoms and at 3 years inly 4 %. Long-term data beyond the 5-year mark are currently being collected.

How safe is LINX?

So far, no deaths have been reported in the first 1,000 patients with a very low complication rate during the surgery or immediately thereafter (0.1 %). Very occasionally the device exerts so much pressure on the esophagus that it works itself through the tissue (erosion). If this happens, device removal will be necessary. This can often be done endoscopically by a gastroenterologist or surgically during laparoscopy.

Why would I be thinking about LINX?

GERD (gastroeophageal reflux disease) has two major components: 1) recurrent acid injury to the esophagus and 2) mechanical backflow (reflux or regurgitation) of gastric contents into the esophagus or throat.

The popular acid inhibitors known as PPIs only address the acid, but cannot prevent stomach contents from moving up the food pipe. This happens especially at night, and this can seriously interfere with a restful sleep, especially if some of the reflux goes into the lungs, causing coughing spells.  Indeed, up to 40 percent of GERD sufferers are not satisfied with medical treatment.

The Caliber randomized controlled trial recently showed that the LINX procedure eliminated regurgitation (backflow) in 92.6 % of patients compared to twice daily omeprazole (8.6 %). This was accompanied by equally impressive quality of life improvements.

Other patients that might want to explore LINX are those who are dependent on PPIs but do not want to take them forever, perhaps being concerned by data from uncontrolled studies that PPIs are associated with a variety of problems.

Where can I get the LINX procedure?

LINX will be available soon in Templeton, CA, and San Luis Obispo, CA.  We will update the post when more info becomes available. There are many patient selection factors that are important and preoperative evaluation by a gastroenterologist is necessary to ensure optimal outcomes. To discuss, make an appointment with Dr. Klaus Gottlieb.

Telem DA, Wright AS, Shah PC, Hutter MM. SAGES technology and value assessment committee (TAVAC) safety and effectiveness analysis: LINX® reflux management system. Surgical endoscopy. 2017 Oct 1;31(10):3811-26.

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