GERD as a Complication of Laparoscopic Sleeve Gastrectomy for the Treatment of Obesity: A Systematic Review and Meta-Analysis

Abstract

Introduction: The incidence of obesity is increasing in developed societies, and surgical treatment is one treatment option. The most common surgical treatment for obesity is laparoscopic sleeve gastrectomy (LSG). Gastroesophageal reflux disease (GERD) is a complication of both obesity and the surgical treatment of obesity. Materials and methods: In this study, the PubMed database was searched using the keywords “GERD” and “bariatric surgery”, and 987 papers published between 1 July 2017 and 30 June 2022 were retrieved. Results: Nine papers met the inclusion criteria and were included in the meta-analysis. The articles were analyzed for the de novo occurrence of GERD after the treatment of its symptoms, the occurrence of erosive esophagitis, and Barrett’s esophagus. In addition, interesting conclusions are presented from the papers that did not meet the inclusion criteria but shed light on the pathophysiology of GERD in obese patients undergoing LSG. Conclusion: In conclusion, the authors draw attention to the need for endoscopic surveillance in patients undergoing LSG, even in the absence of clinical signs of GERD.

Current Management and Treatment Paradigms of Gastroesophageal Reflux Disease following Sleeve Gastrectomy

“…In addition to worsening pre-existing GERD, new-onset or de novo GERD has been widely reported after SG, as detailed in Table 1 . In a recent meta-analysis by Znamirowski et al, the pooled odds ratio (OR) for overall GERD occurrence post-LSG across eight studies and 599 patients was 3.61 (95% confidence interval: 1.92–6.79; p < 0.001) [ 31 ]. The combined percentage of patients with de novo GERD across five studies was 50.8% [ 31 ].…”

“…In a recent meta-analysis by Znamirowski et al, the pooled odds ratio (OR) for overall GERD occurrence post-LSG across eight studies and 599 patients was 3.61 (95% confidence interval: 1.92–6.79; p < 0.001) [ 31 ]. The combined percentage of patients with de novo GERD across five studies was 50.8% [ 31 ]. Across seven studies, the combined percentages of patients with LA Grade C and LA Grade D esophagitis were 4.3% and 3.3%, respectively [ 31 ].…”

“…The combined percentage of patients with de novo GERD across five studies was 50.8% [ 31 ]. Across seven studies, the combined percentages of patients with LA Grade C and LA Grade D esophagitis were 4.3% and 3.3%, respectively [ 31 ]. However, significant heterogeneity was noted in the study [ 31 ].…”

“…Across seven studies, the combined percentages of patients with LA Grade C and LA Grade D esophagitis were 4.3% and 3.3%, respectively [ 31 ]. However, significant heterogeneity was noted in the study [ 31 ]. In addition, there was variability in how GERD was documented, as studies used patients’ symptoms, PPI usage, endoscopic findings, pH testing, esophageal manometry or a combination of these parameters.…”

Endoscopic Management of Post-Sleeve Gastrectomy Complications

“…Data has revealed an association of sleeve gastrectomy with a worsening of pre-existing GERD and the development of de novo GERD [117][118][119][120][121][122][123]. GERD typically manifests as heartburn and regurgitation, although atypical symptoms (i.e., cough, laryngitis, asthma, or chest pain) may be present in some patients.…”