High-resolution impedance manometry and 24-hour multichannel intraluminal impedance with pH testing before and after sleeve gastrectomy: de novo reflux in a prospective series

Chern, Tien Yew; Chan, Daniel L.; Maani, Jason; Talbot, Michael

doi:10.1016/j.soard.2020.09.030

Cited by 23 publications

(17 citation statements)

References 22 publications

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“…Dimbezel et al [ 32 ] found a DeMeester score of 47 in ten symptomatic GERD patients 5 years after SG, which is in line with our results. Other studies reporting 24-h pH-metry only 6 months after SG (+/− hiatoplasty) have found normal DeMeester scores [ 33 , 34 ]. This comparison shows that GERD may occur over time and is not present immediately after the SG.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…We report a 24.5% prevalence of motility disorders according to CCv4.0 criteria, compared to 38.2% when CCv3.0 was applied to our study cohort (P = .04), and similar to reports using CCv3.0 (24.0%-46.0%). 24,26,27 Previously reported motor abnormalities were predominantly IEM, although EGJOO has also been reported. In our study CCv4.0 proportion of IEM was 11.8% (vs 6.7% in healthy volunteers, P = ns) and EGJOO was only seen in obese subjects (8.2%), at rates similar to prior reports.…”

Section: Discussionmentioning

confidence: 97%

Esophageal Physiologic Testing of Obese Subjects as a Part of Bariatric Surgery Planning

Rogers

Bennett

Hobbs

et al. 2021

Foregut: The Journal of the American Foregut Society

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Background: Choice of bariatric procedure may be impacted by esophageal motor disorders and reflux disease, which are not routinely evaluated in obese subjects. Methods: Clinical characteristics on validated questionnaires and esophageal physiologic test findings were collected in 110 consecutive obese subjects (median age 48.5 years, 82% F, median BMI 46.9 kg/m2) evaluated for bariatric surgery. High resolution manometry (HRM) metrics included intragastric pressure (IGP), basal lower esophageal sphincter pressures (LESP), end-expiratory LESP, EGJ contractile integral (EGJ-CI), integrated relaxation pressure (IRP), distal contractile integral (DCI), and Chicago classification (CC) v4.0 diagnoses; acid exposure time (AET, normal if <4%) was obtained from ambulatory reflux monitoring. Comparative analyses determined differences between obese subjects and 15 institutional normal controls (median age 24.7 years, 53% F, median BMI 24.7 kg/m2) and if symptoms predicted abnormal tests. Results: Basal LESP and EGJ-CI were higher in obese subjects ( P = .03) compared to controls, while end-expiratory LESP was similar ( P = .97). IGP was also higher in obese subjects ( P < .0001), which modestly correlated with BMI. The most common CC 4.0 diagnosis was ineffective esophageal motility (IEM, 11.8%). EGJ outflow obstruction was seen in 9.1% and achalasia in 0.9%. Hiatus hernia (type 2 or 3 EGJ morphology) was found in 28%. Of 34 patients completing ambulatory reflux monitoring, 15 (44%) had elevated AET, without symptom or motor predictors. Conclusions: Achalasia, esophageal outflow obstruction, and reflux were encountered in higher than expected proportions without specific symptoms in pre-bariatric surgery patients. Thus, esophageal physiologic testing may be of value prior to bariatric surgery.

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“…While early development of reflux has been reported as a frequent early post-op complication by some authors [ 28 – 30 ], others have shown that clinical reflux can be uncommon after LSG when combined with routine hiatal repair [ 31 ]. Objective pH and manometry data pre and post LSG with liberal use of hiatal reconstruction also show that lower esophageal sphincter function and esophageal acid exposure can remain unchanged pre-and post-operatively [ 32 ]. As telescoping of the sleeve tube in the years after surgery is frequently observed and is strongly associated with the development of reflux symptoms [ 33 ], the concept that a patient who has developed reflux symptoms some years after LSG may be adequately treated by correcting this acquired anatomic abnormality is worthy of consideration.…”

Section: Discussionmentioning

confidence: 99%

Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy

2022

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Background Gastroesophageal reflux is a known complication following laparoscopic sleeve gastrectomy (LSG) as anatomical changes predispose to reduced lower esophageal sphincter pressure and development of hiatus hernia. The mainstay of surgical management has been Roux-en-Y gastric bypass (RYGB) which is not without risk. Hiatus hernia repair (HHR) with surgical reattachment of the oesophagus to the crura, recreating the phreno-esophageal ligament is a simple procedure specifically targeting a number of anatomical changes responsible for reflux in this population. Methods We conducted a single centre retrospective analysis of adult patients with post-sleeve reflux refractory to medical treatment, managed with either HHR, RYGB or One-anastomosis Duodenal switch (OADS). PPI use and symptoms of reflux were assessed at early and mid-term time points via validated questionnaires. Results 99 patients were included, of these the surgical procedure was HHR alone in 58, RYGB in 29 and OADS in 12. At early follow-up control of reflux symptoms was achieved in 72.4% after HHR, 82.1% after RYGB and 100% after OADS with no significant difference between groups (p = 0.09). At mid-term followup (median 10 months IQR 7–21) there was no significant difference in the presence of symptomatic reflux as determined by post-op Visick score nor a difference in PPI use. The GerdQ score was significantly lower after OADS as compared to HHR and RYGB (4.6 ± 2.3 vs 7.7 ± 2.2 vs 8.7 ± 3.5, p = 0.006). Conclusion HHR with reconstruction of the phreno-esophageal ligament is a safe and effective procedure for patients with reflux after LSG, that avoids more complex operations such as RYGB and OADS and their associated long-term sequelae.

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High-resolution impedance manometry and 24-hour multichannel intraluminal impedance with pH testing before and after sleeve gastrectomy: de novo reflux in a prospective series

Cited by 23 publications

References 22 publications

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

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

Esophageal Physiologic Testing of Obese Subjects as a Part of Bariatric Surgery Planning

Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy

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