Fifteen Years after Sleeve Gastrectomy: Gastroscopies, Manometries, and 24-h pH-Metries in a Long-Term Follow-Up: A Multicenter Study

Abstract

Introduction: Sleeve gastrectomy (SG) is the most common bariatric operation with over 340,000 procedures per year. There are only few studies presenting follow-up results >10 years in the literature today. The aim of this study was the objective evaluation of long-term outcomes of at least 15 years after SG in non-converted patients. Methods: This study (multicenter cross-sectional; university-hospital based) includes all non-converted patients with primary SG before December 2005 at participating bariatric centers. The following methods were used: gastroscopy, esophageal manometry, 24-h pH-metry, and Gastrointestinal Quality of Life Index (GIQLI). Results: After removing converted patients, patients with bariatric procedures before SG, and deceased patients from the cohort, 20 of 53 participants have met the inclusion criteria. Of this group, 55% are suffering from symptomatic gastroesophageal reflux disease (GERD); 45% are without GERD. Esophagitis, hiatal hernias, Barrett’s esophagus, and enlarged sleeves were found in 44%, 50%, 13%, and 69% of patients during gastroscopy. Mean lower esophageal sphincter pressure was normal at 20.2 ± 14.1 mm Hg during manometry. Reflux activity in 24 h, number of refluxes, and DeMeester score were increased at 12.9 ± 9.7%, 98.0 ± 80.8, and 55.3 ± 36.3 during 24-h pH-metry. Patients with GERD scored significantly lower in the GIQLI than patients without GERD: 107.6 ± 18.4 versus 127.6 ± 14.4 (p = 0.04). Discussion/Conclusion: Fifteen years after primary SG, objective testing has shown that GERD, esophagitis, and Barrett’s esophagus are major issues for these patients. Surveillance endoscopies at 5-year intervals in all SG patients and 3-year intervals in patients with Barrett’s esophagus are recommended.

No Long-Term Mucosal Lesions in the Esophagus but More Gastric Mucosal Lesions after Sleeve Gastrectomy in Obese Rats

“…These results have also been reported in rats at 5 weeks [20], 12 weeks [21], and 16 weeks after SG [21]. In humans, weight regain after SG is also often observed after 2 or 3 postoperative years, and it is always observed in studies with 10-or 15-years postoperative follow-up [14][15][16][17].…”

“…To our knowledge, only one study has reported the results of gastric biopsies performed at 15 years postoperatively in 16 patients. The authors found "active gastritis" in 75% of the 16 patients, but no other type of gastric lesion was described [17]. Furthermore, the prevalence of gastric intestinal metaplasia in postoperative gastric biopsies has never been reported in humans, whereas this prevalence is estimated to be approximately 2.7% in gastric specimens and gastric biopsies performed during preoperative endoscopy, according to a recent review by Wang et al [29].…”

“…This latter paper is also the only one to report findings of gastric biopsies during endoscopy. The authors found active gastritis in more than 70% of the 20 patients, without significant differences between patients with or without GERD [17].…”

“…The follow-up of the most recent endoscopic studies is only up to 10 years [14][15][16], because SG is a relatively new procedure worldwide. Only one paper has reported endoscopic findings at 15 years in 20 patients, finding BE in 13% of them [17]. This latter paper is also the only one to report findings of gastric biopsies during endoscopy.…”

Esophageal function and non-acid reflux evaluated by impedance-24 h-pH-metry, high-resolution manometry, and gastroscopy after one-anastomosis gastric bypass—outcomes of a prospective mid-term study

“…Comparing the results of this study to the literature available on SG [ 27 ], one can summarize that acid reflux is a problem in the long-term follow-up after SG but seems to improve after OAGB. Nevertheless, the increasing rates of non-acid reflux after OAGB are a potentially dangerous finding that must be kept in mind.…”