Abstract

Magnetic sphincter augmentation (LINX) is a physiology-preserving treatment for gastroesophageal reflux disease that augments lower esophageal sphincter tone while maintaining the ability to belch and vomit. This review synthesizes current evidence on patient selection, operative technique, postoperative care, outcomes, and revision strategies. We outline a practical pathway that starts with objective reflux testing and high-resolution manometry, pairs implantation with durable posterior cruroplasty and correct sizing, and uses a structured early “device cycling” diet to reduce dysphagia. Longitudinal cohorts show sustained symptom relief, reduced proton pump inhibitor use, and favorable quality of life. Early dysphagia is common but typically improves with coaching and hydration, and most persistent cases respond to one or two graded dilations. When removal is necessary, conversion to fundoplication is usually feasible with good results.
Comparative studies position LINX alongside fundoplication, with a trade-off between strict acid normalization and preservation of physiologic venting that supports shared decision-making. The 2024 expansion of the United States label to include symptomatic Barrett’s esophagus broadens candidacy and underscores the need for coordinated endoscopic surveillance. Growing experience in post-bariatric patients suggests a role for LINX when a durable cruroplasty is feasible and a severe motility disorder is absent. A characteristic late failure pattern involves recurrent hiatal hernia with ring slippage or migration, which highlights the value of meticulous hiatal repair and a low threshold for anatomic evaluation during follow-up. Future priorities include phenotype-stratified comparative studies, Barrett’s and post-bariatric registries, and engineering responses that reduce hernia-linked failure while preserving the physiologic benefits that distinguish LINX.