Correlation Between Symptomatic Gastro-Esophageal Reflux Disease (GERD) and Erosive Esophagitis (EE) Post-vertical Sleeve Gastrectomy (VSG)

Lim, Chin Hong; Lee, Phong Ching; Lim, Ee Jean; Tan, Jeremy; Chan, Weng Hoong; Ganguly, Sonali; Tham, Kwang Wei; Eng, Alvin

doi:10.1007/s11695-018-3509-0

Cited by 44 publications

(27 citation statements)

References 30 publications

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“…However, its reputation is marred by insufficient weight loss (IWL) or even weight regain (WR). Gastro-esophageal reflux disease (GERD) or erosive esophagitis (EE) unresponsive to medical management has also been frequently reported in these patients [ 6 ]. Treatments described in the literature include medical therapies and surgical conversion to a different bariatric procedure.…”

Section: Discussionmentioning

confidence: 99%

“…In our previous study, the prevalence of GERD symptoms increased from 31.7% to 47.6% after LSG. Thirty-two percent experienced new GERD symptoms, and 15.9% patients experienced worsening in preexisting GERD symptoms [ 6 ]. DuPree at el.…”

Section: Discussionmentioning

confidence: 99%

“…The standardized surgical technique of LSG adopted by all surgeons at our unit has been previously reported [ 6 ]. LSG was performed using five ports placed in upper abdomen through the anterior abdominal wall.…”

Section: Methodsmentioning

confidence: 99%

“…However, there is one shortcoming of LSG in the long-term follow-up, and this is the onset of gastro-esophageal reflux disease (GERD) and erosive esophagitis (EE). Our previous study showed 31.7% patients experienced new GERD symptoms after sleeve gastrectomy, and the prevalence of erosive esophagitis (EE) increased from 14.3 to 44.4% [ 6 ]. Those patients are unresponsive to optimal medical management, and in the absence of a correctable anatomic factor, conversion to RYGB is considered the reasonable approach.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, many studies which use this indicator in their study are prone to bias ( Table 1 ) . More importantly, our previous study has shown there was no correlation between GERD symptomology with endoscopic evidence of erosive esophagitis post sleeve gastrectomy [ 6 ]. Hence, it would be imperative to assess the EE resolution post conversion surgery with objective measurement such as endoscopic evaluation with accepted classification system.…”

Section: Introductionmentioning

confidence: 99%

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Resolution of Erosive Esophagitis After Conversion from Vertical Sleeve Gastrectomy to Roux-en-Y Gastric Bypass

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Background Laparoscopic sleeve gastrectomy (LSG) has become the preferred bariatric procedure in many countries. However, there is one shortcoming of LSG in the long-term follow-up, and this is the onset of gastro-esophageal reflux disease (GERD) and erosive esophagitis (EE). Conversion to Roux-en-Y gastric bypass (RYGB) is considered an option in patients unresponsive to medical therapy. Currently, there is no evidence of EE improvement or resolution after conversion surgery. In this study, we objectively evaluate the effectiveness of RYGB in management of EE with upper endoscopy (EGD) to identify the significant variables in patients with GERD symptoms post LSG refractory to medical therapy and require conversion surgery. Methods Over a period of 11 years (2008–2019) at Singapore General Hospital, we retrospectively reviewed a prospectively collected database of a cohort of patients whom had conversion surgery to RYGB for refractory GERD and EE after LSG. Patient’s endoscopic findings and demographic and anthropometric data were analyzed. Results We identified a total of 14 patients who underwent LSG to RYGB conversions for endoscopic proven erosive esophagitis in our unit during the study period. Eight patients (57.1%) had concurrent hiatal hernia repaired. Nine (64.3%) patients were females. The median age of patients in this cohort was 44 (range 30–61) years. Mean weight and BMI were 87.7 kg (± 19.2) and 32.8 (± 3.09) kg/m2, respectively, on the day of conversion surgery. The median time between LSG and revision to RYGB was 36 (range 6–68) months. Seven patients (50%) had complete resolution of GERD symptoms after conversion, and 6 patients (42.9%) had partial resolution. Six out of 7 patients had complete resolution of EE. There were 4 anastomotic strictures (28.6%). Older patients, Indian ethnicity, present of hiatal hernia and lower weight loss after initial LSG were more likely to undergo conversion surgery. Conclusion Conversion to RYGB after LSG is clinically relevant and may be a feasible solution if patients have ongoing GERD refractory to medical therapy. Ninety-three percent of our patients achieved complete resolution of their GERD symptoms and significant improvement of erosive esophagitis with significant weight loss after conversion. This study has important implications as LSG is increasingly being performed and a proportion of these will need revision surgery for various reasons, particularly GERD which is extremely prevalent.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Resolution of Erosive Esophagitis After Conversion from Vertical Sleeve Gastrectomy to Roux-en-Y Gastric Bypass

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Associations of Bariatric Interventions With Micronutrient and Endocrine Disturbances

et al. 2020

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IMPORTANCE Few studies have described the longitudinal trajectories of serum levels of micronutrients whose deficiencies are associated with serious sequelae following bariatric procedures, such as anemia, osteoporotic fractures, and neuropathies. Furthermore, previous studies comparing laparoscopic sleeve gastrectomy (LSG) vs Roux-en-Y gastric bypass (LRYGB) or one-anastomosis gastric bypass (OAGB) procedures may have been limited by selection and confounding biases.OBJECTIVE To appraise the spectrum and temporal course of micronutrient deficiencies associated with bone metabolism and erythropoiesis after LSG vs OAGB or LRYGB procedures, using the propensity score as a balancing score.

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Gastroesophageal Reflux Disease After Sleeve Gastrectomy

Iannelli

Martini

2020

The Perfect Sleeve Gastrectomy

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Correlation Between Symptomatic Gastro-Esophageal Reflux Disease (GERD) and Erosive Esophagitis (EE) Post-vertical Sleeve Gastrectomy (VSG)

Cited by 44 publications

References 30 publications

Resolution of Erosive Esophagitis After Conversion from Vertical Sleeve Gastrectomy to Roux-en-Y Gastric Bypass

Resolution of Erosive Esophagitis After Conversion from Vertical Sleeve Gastrectomy to Roux-en-Y Gastric Bypass

Associations of Bariatric Interventions With Micronutrient and Endocrine Disturbances

Gastroesophageal Reflux Disease After Sleeve Gastrectomy

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