Predictive Factors of Gastroesophageal Reflux Disease in Bariatric Surgery: a Controlled Trial Comparing Sleeve Gastrectomy with Gastric Bypass

Navarini, Daniel; Madalosso, Carlos Augusto Scussel; Tognon, Alexandre Pereira; Fornari, Fernando; Barão, Fábio Roberto; Gurski, Richard Ricachenevsky

doi:10.1007/s11695-019-04286-5

Cited by 62 publications

(29 citation statements)

References 38 publications

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“…Two further studies comparing the effects of both SG and RYGB on postoperative GERD in the short-term, by means of symptomatic assessment, functional investigations (i.e., HRM, 24-h pH monitoring, barium swallow), and endoscopy, confirmed how the development of postoperative GERD was significantly greater in SG than in patients who underwent RYGB, suggesting that SG should be contraindicated in those patients already presenting with reflux symptoms at baseline and that extensive counseling explaining all possible reflux-related consequences should be performed before an SG procedure [27,28].…”

Section: Discussionmentioning

confidence: 88%

Sleeve gastrectomy and gastroesophageal reflux: a comprehensive endoscopic and pH-manometric prospective study

Castagneto-Gissey

Genco

Corpo

et al. 2020

Surgery for Obesity and Related Diseases

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Background: The impact of sleeve gastrectomy (SG) on gastroesophageal reflux disease (GERD) is still greatly debated. Most of the current evidence available is solely based on symptom evaluation or medication use, while a minority have implemented objective functional measurements. Objective: To better comprehend the pathophysiological mechanisms involved in the genesis of GERD after SG. Setting: University Hospital, Italy. Methods: A total of 21 patients affected by morbid obesity and eligible for SG were prospectively enrolled in the present study. Patients were evaluated by means of endoscopy, high-resolution manometry (HRM), 24-hour pH monitoring, and the Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire. Results: Follow-up was completed at least 1 year post operation (mean follow-up, 14.3 6 2.1 mo) by 19 patients. Body mass index decreased from 41.2 6 .9 to 26.8 6 .8 kg/m 2 (P , .001). Distal contractile integral significantly decreased from 2772.8 6 399.9 mm Hg/s/cm to 2060.4 6 338.9 mm Hg/ s/cm (P 5 .01). The 24-hour pH monitoring showed an overall reduction tendency of acid reflux, although this was not statistically significant. All analyzed endoscopic findings withstood substantial pejorative modifications after SG (P , .01). Distal contractile integral values at baseline predicted postoperative Z-line upward migration; HRM, distal latency, and DeMeester score at baseline predicted the development of erosive esophagitis at follow-up, by bootstrap estimates of a logistic regression. Conclusions: Postoperative GERD-related esophageal sequelae should be carefully considered after SG. Our results demonstrate how acid reflux does not seem to play a relevant role in the pathophysiology of post-SG GERD. Baseline HRM can help stratify the risk of developing erosive esophagitis and Z-line upward migration after SG, while postoperative endoscopic surveillance should be encouraged regardless of the presence or absence of symptoms. (Surg Obes Relat Dis 2020;-:1-9.

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Section: Discussionmentioning

confidence: 88%

Sleeve gastrectomy and gastroesophageal reflux: a comprehensive endoscopic and pH-manometric prospective study

Castagneto-Gissey

Genco

Corpo

et al. 2020

Surgery for Obesity and Related Diseases

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“…27 While most of the reported studies are retrospective reviews, Navarini et al recently reported results of a controlled trial that looked at predictive factors of GERD in 75 patients, 40 (53.3%) of which underwent SG during a 1-year follow-up. 28 When compared with RYGB, GERD following SG was more frequent (74 vs. 26%, p < 0.001) despite it being less commonly seen preoperatively in the SG group compared with the RYGB group (20 vs. 40%, p < 0.061). 28 While the incidence of de novo GERD was reported to be 67.9%, all patients with preexisting symptoms continued to have them, thus demonstrating that SG and preoperative esophagitis were independent predictors of developing GERD symptoms postoperatively (odds ratio [OR]: 12.3, 95% confidence interval [CI]: 2.9-52.5 and OR: 8.5, 95% CI: 1.6-44.8, respectively).…”

Section: Gastroesophageal Reflux Disease Post-sleeve Gastrectomymentioning

confidence: 85%

“…28 When compared with RYGB, GERD following SG was more frequent (74 vs. 26%, p < 0.001) despite it being less commonly seen preoperatively in the SG group compared with the RYGB group (20 vs. 40%, p < 0.061). 28 While the incidence of de novo GERD was reported to be 67.9%, all patients with preexisting symptoms continued to have them, thus demonstrating that SG and preoperative esophagitis were independent predictors of developing GERD symptoms postoperatively (odds ratio [OR]: 12.3, 95% confidence interval [CI]: 2.9-52.5 and OR: 8.5, 95% CI: 1.6-44.8, respectively). 28 Some studies, however, report significant resolution of GERD symptoms following SG.…”

Section: Gastroesophageal Reflux Disease Post-sleeve Gastrectomymentioning

confidence: 85%

“…28 While the incidence of de novo GERD was reported to be 67.9%, all patients with preexisting symptoms continued to have them, thus demonstrating that SG and preoperative esophagitis were independent predictors of developing GERD symptoms postoperatively (odds ratio [OR]: 12.3, 95% confidence interval [CI]: 2.9-52.5 and OR: 8.5, 95% CI: 1.6-44.8, respectively). 28 Some studies, however, report significant resolution of GERD symptoms following SG. One such study retrospectively looked at 134 patients who underwent SG noting that though GERD prevalence preoperatively was 49.2%, postoperative GERD was noted only in approximately 1.5% of patients at up to 12 months of follow-up.…”

Section: Gastroesophageal Reflux Disease Post-sleeve Gastrectomymentioning

confidence: 99%

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Interventions for the Management of Post–Sleeve GERD

Jain-Spangler

Chumakova-Orin

2021

Digestive Disease Interventions

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Over the last decade, sleeve gastrectomy (SG) has steadily gained popularity and has now become the most commonly performed bariatric procedure in the United States. It is technically less complex than Roux-en-Y gastric bypass (RYGB) or biliopancreatic diversion with duodenal switch and has relatively good weight loss results in addition to comorbidity resolution. The long-term complication profile is appealing to patients and surgeons alike, save one issue, gastroesophageal reflux disease (GERD). GERD is frequently seen in bariatric surgery patients; thus, proper patient selection for SG is paramount. However, SG effects on GERD remain controversial in the literature. Thus, patients are intensively cautioned of the possibility of de novo GERD or worsening of already existing GERD following SG. Therefore, it is imperative that the discussion also occurs regarding potential treatment options if GERD does occur. GERD management following SG consists of a multitude of options. While lifestyle modifications and proton pump inhibitors remain the initial treatment of choice, some will have persistent symptoms needing additional interventions, which may range from a variety of endoscopic techniques (lower esophageal sphincter [LES], radiofrequency ablation, magnetic LES augmentation, and antireflux mucosectomy) to ReSleeve and ultimately conversion to RYGB.

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“…To the best of our knowledge, this is the first study reporting results of a prospective randomized controlled trial comparing specifically GEJ function after MGB/OAGB and SG with 1-year FU [ 63 ]. Main strength of this study is a full evaluation with endoscopy, manometry, and clinical assessment of GERD.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1-year results from a randomized open-label controlled trial

et al. 2020

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Background Recent reports have demonstrated that de novo reflux and worsening of pre-existing symptoms occur after SG; concerns are still expressed about the risk of symptomatic biliary reflux gastritis and oesophagitis. The aim of our study was to investigate and compare the rate of postoperative acid and non-acid reflux following Mini-/One anastomosis gastric bypass (MGB/OAGB) and laparoscopic sleeve gastrectomy (LSG). Study design A prospective randomized open-label, controlled trial registered on clinicaltrial.gov (NCT number: NCT02987673) has been carried out to evaluate esophagogastric junction exposure to reflux in the first year after MGB/OAGB and LSG using high impedance manometry, endoscopy, and a validated questionnaire. Results A total of 58 individuals were eventually enrolled in this trial and represented the per-protocol population (n = 28 MGB/OAGB, n = 30 LSG). No difference was found between the two groups in terms of demographic characteristics, PAGI-SYM score, acid exposure time percent of the esophagus (AET%), esophagitis, and other HRiM and MII-pH data at baseline. Comparing MII-pH outcomes of the two groups, AET% resulted significantly higher after LSG at 12 months. Endoscopic findings showed a significant increase of esophagitis ≥ B in the LSG group after 1 year; postoperative esophagitis ≥ B resulted also significantly worsened after LSG when compared to MGB/OAGB. Conclusion Since AET% and rate of esophagitis are significantly higher after LSG when compared to MGB/OAGB, this procedure should be preferred in case of preoperative subclinical reflux or low grade (A) esophagitis.

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Predictive Factors of Gastroesophageal Reflux Disease in Bariatric Surgery: a Controlled Trial Comparing Sleeve Gastrectomy with Gastric Bypass

Cited by 62 publications

References 38 publications

Sleeve gastrectomy and gastroesophageal reflux: a comprehensive endoscopic and pH-manometric prospective study

Sleeve gastrectomy and gastroesophageal reflux: a comprehensive endoscopic and pH-manometric prospective study

Interventions for the Management of Post–Sleeve GERD

Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1-year results from a randomized open-label controlled trial

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