Can magnetic sphincter augmentation devices erode after sleeve gastrectomy surgery for GERD?

Magnetic sphincter augmentation (MSA) is a less invasive surgical option for GERD, but in patients who have had sleeve gastrectomy, the risk of device erosion is a real concern. Erosion means the device wears through the esophageal wall. A 2025 meta-analysis found that the erosion rate after sleeve gastrectomy is much higher than in people who have not had bariatric surgery. This is important to discuss with your surgeon if you are considering MSA after sleeve gastrectomy.

What the research says

A 2025 systematic review and meta-analysis of 14 studies involving 287 patients who had MSA after sleeve gastrectomy found an overall device erosion rate of 3.8% (11 out of 287 patients) over a median follow-up of 24 months ³. This is significantly higher than the 0.1% to 0.3% erosion rate reported in non-bariatric populations ³⁶. The median time to erosion was 18 months ³. Risk factors for erosion included a body mass index over 30 at the time of MSA, not repairing a hiatal hernia, using an undersized device, and persistent sleeve dilatation ³. In the general population, erosion is rare, with a 2018 study of nearly 9,500 devices reporting a 0.3% risk at 4 years ⁶. Erosion typically presents with new or worsening difficulty swallowing (dysphagia) ⁶⁷. Devices can often be removed endoscopically or laparoscopically, with good outcomes ⁶⁷.

What to ask your doctor

• What is my personal risk of device erosion given my history of sleeve gastrectomy?
• Have you performed MSA in patients after sleeve gastrectomy, and what were the outcomes?
• What steps can be taken during surgery to lower the risk of erosion, such as hiatal hernia repair?
• What symptoms should I watch for that might indicate device erosion?
• If erosion occurs, what treatment options are available and what is the success rate?