Magnetic sphincter augmentation and high-resolution manometry: impact of biomechanical properties on esophageal motility and clinical significance for selection and outcomes.

This article focuses on magnetic sphincter augmentation (MSA) as an alternative to laparoscopic Nissen fundoplication (LNF) for treating gastroesophageal reflux disease (GERD). MSA involves implanting a ring of magnetic beads around the esophagogastric junction (EGJ) to augment the lower esophageal sphincter (LES) by increasing its length and resting pressure, thereby restoring reflux barrier function. Unlike LNF, MSA’s magnetic forces do not relax during swallowing, placing greater demand on esophageal body contractility to overcome increased EGJ resistance, which is measurable by manometry. Preoperative manometric evaluation is critical for assessing esophageal motility and contractile reserve to predict patient suitability and risk of postoperative dysphagia, with manometric thresholds for MSA outcomes differing from standard motility disorder classifications.