Gastroesophageal Reflux Disease Outcomes After Vertical Sleeve Gastrectomy and Gastric Bypass

Abstract

Objective: The objective of this study is to assess whether vertical sleeve gastrectomy (VSG) increases the incidence of gastroesophageal reflux disease (GERD), esophagitis and Barrett esophagus (BE) relative to patients undergoing Roux-en-Y gastric bypass (RYGB) in patients with and without preoperative GERD. Summary of Background Data: Concerns for potentiation of GERD, supported by multiple high-quality retrospective studies, have hindered greater adoption of the VSG. Methods: From the OptumLabs Data Warehouse, VSG and RYGB patients with ≥2 years enrollment were identified and matched by follow-up time. GERD [reflux esophagitis, prescription for acid reducing medication (Rx) and/or diagnosis of BE], upper endoscopy (UE), and re-admissions were evaluated beyond 90 days. Results: A total of 8362 patients undergoing VSG were matched 1:1 to patients undergoing RYGB, on the basis of post-operative follow-up interval. Age, sex, and follow-up time were similar between the 2 groups (P > 0.05). Among all patients, postoperative GERD was more frequently observed in VSG patients relative to RYGB patients (60.2% vs 55.6%, respectively; P < 0.001), whereas BE was more prevalent in RYGB patients (0.7% vs 1.1%; P = 0.007). Postoperatively, de novo esophageal reflux symptomatology was more common in VSG patients (39.3% vs 35.3%; P < 0.001), although there was no difference in development of the histologic diagnoses reflux esophagitis and BE. Furthermore, postoperative re-admission was higher in the RYGB cohort (38.9% vs 28.9%; P < 0.001). Conclusions: Compared to RYGB, VSG may not have inferior long-term GERD outcomes, while also leading to fewer re-hospitalizations. These data challenge the prevailing opinion that patients with GERD should undergo RYGB instead of VSG.

Comparison of Sleeve Gastrectomy vs Intensive Lifestyle Modification in Patients With a BMI of 30 to Less Than 35

“…Some studies have reported alarming numbers of Barrett esophagus among patients with these complications, 25 whereas others have not. 26 Substance use disorder, treatment for depression and anxiety, and health care encounters for self-harm were all increased in the surgery group compared with the intensive lifestyle treatment group. These problematic side effects have been reported earlier after gastric surgery for duodenal ulcer 27 and later for RYGB.…”

The impact of bariatric and metabolic surgery on cancer development

“…In all guidelines, a screening gastroscopy is recommended as a routine preoperative diagnostic test to assess Helicobacter pylori-and reflux esophagitis, the significant risk factor for Barrett's esophagus and esophageal cancer (38,39). However, the absolute necessity of this examination is still under debate and remains controversial (1,38,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50).…”

“…While the incidence of reflux esophagitis after sleeve gastrectomy increases by about 30%, Y-Roux gastric bypass is the state-of-the-art bariatric and metabolic surgery against both obesity and reflux esophagitis (10,12,13,44,46). In addition, hiatal hernias, which are very common in patients with reflux esophagitis, can also be treated surgically simultaneously (8,(44)(45)(46)(47)(48)(49)(50).…”

“…In non-invasive weight loss therapies like diets or drug therapies, such as treatment with GLP-1-receptor agonists, these screening examinations are not even considered to use for tumor screening (4,6). However, these obese patients tend to have the same risk of developing cancer as those undergoing bariatric and metabolic surgery (8,(44)(45)(46)(47)(48)(49)(50).…”

“…Clear criteria for a preoperative endoscopy (gastro-and colonoscopy) for specific risk groups are needed to adequately select patients benefiting from such detailed screening examinations (1,4,6,8,9,38), and a selective endoscopy in these patients might be more appropriate in the tumor screening before bariatric and metabolic surgery (38,(41)(42)(43)(44)(45)(46)(47)(48)(49)(50).…”