Systematic review and meta-analysis finds elevated magnetic sphincter augmentation erosion after sleeve gastrectomy

BACKGROUND: Gastroesophageal reflux disease following laparoscopic sleeve gastrectomy (LSG) affects up to 40% of patients. Magnetic sphincter augmentation (MSA) has emerged as a less invasive alternative to Roux-en-Y gastric bypass, but device erosion remains a critical concern in postbariatric populations. OBJECTIVES: To evaluate MSA erosion rates after LSG and compare them with general populations, while identifying risk factors and clinical outcomes. SETTING: Multi-institutional systematic review and meta-analysis. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus through September 2025. Primary outcome was device erosion rate. Secondary outcomes included time to erosion, risk factors, clinical presentation, and management. Random-effects meta-analysis with heterogeneity assessment was performed. RESULTS: Analysis of 14 studies encompassing 287 patients with median follow-up of 24 months revealed overall erosion rate of 3.8% (11/287), significantly higher than .1%-.3% in nonbariatric populations (P < .001). Median time to erosion was 18 months. Factors associated with erosion included body mass index > 30 kg/m at MSA (odds ratio [OR]: 3.2), absence of hiatal repair (OR: 4.1), device undersizing (OR: 3.8), and persistent sleeve dilatation (OR: 2.7). Most erosions (72.7%) presented with dysphagia; all required explantation with 90.9% symptom resolution. CONCLUSIONS: MSA erosion risk after LSG is elevated compared to nonbariatric populations but remains below 4% with proper patient selection, and must be weighed against the 7%-8% complication rate of Roux-en-Y gastric bypass conversion. Based on very low to low-certainty evidence, body mass index optimization, adequate hiatal repair, appropriate device sizing, and sleeve evaluation may help minimize erosion risk in this population, although these recommendations require prospective validation.