GORD and Barrett’s oesophagus after bariatric procedures: multicentre prospective study

Genco, Alfredo; Castagneto-Gissey, Lidia; Gualtieri, Loredana; Lucchese, Marcello; Leuratti, Luca; Soricelli, Emanuele; Casella, Giovanni

doi:10.1093/bjs/znab330

Cited by 33 publications

(15 citation statements)

References 36 publications

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“…Again, concordant to the current literature evidence for LINX® magnetic sphincter device is low, since only a few cohort studies exist [32][33][34]. Cruroplasty/hiatal hernia repair might not be taken into consideration, since SG remains a high-pressure system and GERD seems to improve only after RYGB [35].…”

Section: Symptomatic Gerd After Sg and Excessive Weight Losssupporting

confidence: 56%

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Kermansaravi

Parmar

Chiappetta³

et al. 2023

Surg Endosc

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Background Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. Methods Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. Results Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redoprocedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. Conclusion Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

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Section: Symptomatic Gerd After Sg and Excessive Weight Losssupporting

confidence: 56%

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Kermansaravi

Parmar

Chiappetta³

et al. 2023

Surg Endosc

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“…This is in striking contrast with data from South America, where RYGB remains central and accounts for around 60% of BS activity and with Asia where RYGB was historically around 10% and remained so [ 13 , 14 ]. RYGB remains considered by many the gold standard BS technique, due to its long-standing efficacy and safety and its superiority in the treatment of GERD [ 19 ]. However, RYGB is technically complex and long-term data have evidenced its fallibility [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…This was unprecedented in previous studies. This trend is probably the result of tapering off of the initial enthusiasm, as time has made clear that SG has its own limitations including sub-optimal long-term efficacy and difficult-to-manage complications such as gastric leak and chronic GERD [15][16][17][18][19]. In fact, the absolute reduction in main non-malabsorptive procedures although small (6% between 2011 and 2021) was indeed significant.…”

Section: Discussionmentioning

confidence: 99%

Evolution of Bariatric Surgery in Italy in the Last 11 Years: Data from the SICOB Yearly National Survey

et al. 2023

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Background Bariatric surgery (BS) is a relatively novel surgical field and is in continuous expansion and evolution. Purpose Aim of this study was to report changes in Italian surgical practice in the last decade. Methods The Società Italiana di Chirurgia dell’Obesità (SICOB) conducted annual surveys to cense activity of SICOB centers between 2011 and 2021. Primary outcome was to detect differences in frequency of performance of adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), bilio-pancreatic diversion (BPD), and gastric plication (GP). Secondary outcome was to detect differences in performance of main non-malabsorptive procedures (AGB + SG) and overall bypass procedures (RYGB + OAGB). Geographical differences were also investigated. Results Median response rate was 92%. AGB declined from 36% of procedures in 2011 to 5% in 2021 (p < 0.0001). SG increased from 30% in 2011 to 55% in 2021 (p < 0.0001). RYGB declined from 25 to 12% of procedures (p < 0.0001). OAGB rose from 0% of procedures in 2011 to 15% in 2021 (p < 0.0001). BPD underwent decrease from 6.2 to 0.2% in 2011 and 2021, respectively (p < 0.0001). Main non-malabsorptive procedures significantly decreased while overall bypass procedures remained stable. There were significant differences among regions in performance of SG, RYGB, and OAGB. Conclusions BS in Italy evolved significantly during the past 10 years. AGB underwent a decline, as did BPD and GP which are disappearing and RYGB which is giving way to OAGB. The latter is rising and is the second most-performed procedure after SG which has been confirmed as the preferred procedure by Italian bariatric surgeons. Graphical Abstract

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“…They found that RYGB was superior to OAGB and SG, not only in terms of GERD symptoms but also when monitoring Gastritis, Barrett´s esophagus, anastomotic inflammation, and biliary reflux to the stomach and esophagus. Only in terms of marginal ulcers, OAGB and RYGB were not significantly different [ 28 ]. On the other hand, the latest update (10 years of follow-up) of the SLEEVEPASS trial by Salminen et al showed that both in SG and RYGB Barrett´s esophagus rates were low (4%), even with much higher symptomatic de-novo reflux rates.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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Background One-Anastomosis Gastric Bypass (OAGB) is the third most common bariatric operation for patients with obesity worldwide. One concern about OAGB is the presence of acid and non-acid reflux in a mid- and long-term follow-up. The aim of this study was to objectively evaluate reflux and esophagus motility by comparing preoperative and postoperative mid-term outcomes. Setting Cross-sectional study; University-hospital based. Methods This study includes primary OAGB patients (preoperative gastroscopy, high-resolution manometry (HRM), and impedance-24 h-pH-metry) operated at Medical University of Vienna before 31st December 2017. After a mean follow-up of 5.1 ± 2.3 years, these examinations were repeated. In addition, history of weight, remission of associated medical problems (AMP), and quality of life (QOL) were evaluated. Results A total of 21 patients were included in this study and went through all examinations. Preoperative weight was 124.4 ± 17.3 kg with a BMI of 44.7 ± 5.6 kg/m2, total weight loss after 5.1 ± 2.3 years was 34.4 ± 8.3%. In addition, remission of AMP and QOL outcomes were very satisfactory in this study. In gastroscopy, anastomositis, esophagitis, Barrett´s esophagus, and bile in the pouch were found in: 38.1%, 28.3%, 9.5%, and 42.9%. Results of HRM of the lower esophageal sphincter pressure were 28.0 ± 15.6 mmHg, which are unchanged compared to preoperative values. Nevertheless, in the impedance-24 h-pH-metry, acid exposure time and DeMeester score decreased significantly to 1.2 ± 1.2% (p = 0.004) and 7.5 ± 8.9 (p = 0.017). Further, the total number of refluxes were equal to preoperative; however, the decreased acid refluxes were replaced by non-acid refluxes. Conclusion This study has shown decreased rates of acid reflux and increased non-acid reflux after a mid-term outcome of primary OAGB patients. Gastroscopy showed signs of chronic irritation of the gastrojejunostomy, pouch, and distal esophagus, even in asymptomatic patients. Follow-up gastroscopies in OAGB patients after 5 years may be considered. Graphical Abstract

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GORD and Barrett’s oesophagus after bariatric procedures: multicentre prospective study

Cited by 33 publications

References 36 publications

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Evolution of Bariatric Surgery in Italy in the Last 11 Years: Data from the SICOB Yearly National Survey

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

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