Does Sleeve Gastrectomy Worsen Gastroesophageal Reflux Disease in Obese Patients? A Prospective Study. (October 2022)

• Record Type: Journal Article
• Authors: Balla, Andrea; Palmieri, Livia; Corallino, Diletta; Meoli, Francesca; Carlotta Sacchi, Maria; Ribichini, Emanuela; Pronio, Annamaria; Badiali, Danilo; Paganini, Alessandro M.
• Is Part Of: Surgical innovation. Volume 29:Number 5(2022)
• Page Start: 579
• Page End: 589
• Publication Date: 2022-10
• Subjects: gastroesophageal reflux disease (GERD) -- laparoscopic sleeve gastrectomy -- laparoscopic gastric bypass -- manometry -- pH-manometry -- 24h-pH-impedance -- bariatric surgery; Surgery, Operative -- Periodicals; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgical Procedures, Minimally Invasive -- Periodicals; Diffusion of Innovation -- Periodicals; Chirurgie opératoire -- Périodiques; Chirurgie endoscopique -- Périodiques; Chirurgie laparoscopique -- Périodiques; 617.91
• DOI: 10.1177/15533506211052745
• Languages: English
• ISSNs: 1553-3506

Abstract

Background: To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) and gastric bypass (LGB) on gastroesophageal reflux disease (GERD). Methods: GERD was evaluated by the Modified Italian Gastroesophageal reflux disease—Health-Related Quality of Life (MI-GERD-HRQL) questionnaire, pH-manometry, endoscopy, and Rx-esophagogram, before and 12 months after surgery. Based on these exams, patients without GERD underwent LSG, and patients with GERD underwent LGB. Results: Thirteen and six patients underwent LSG and LGB, respectively. After LSG, the only statistically significant difference observed at pH-manometry was the median DeMeester score, from 5.7 to 22.7 (P = .0026). De novo GERD occurred in 6 patients (46.2%), with erosive esophagitis in one. The median MI-GERD-HRQL score improved from 3 to 0. Overall, nine patients underwent LGB, but three were lost to follow-up. Preoperative pH-manometry changed the surgical indication from LSG to LGB in 7 out of 9 patients (77.8%). Six patients who underwent LGB completed the study, and at pH-manometry, statistically significant differences were observed in the percentage of total acid exposure time, with the number of reflux episodes lasting >5 minutes and DeMeester score (P = .009). The median MI-GERD-HRQL score improved from 6.5 to 0. Statistically significant differences were not observed at endoscopy and Rx-esophagogram findings in both groups. Conclusions: LSG has a negative impact on GERD, even in patients without preoperative GERD. LGB confirmed to be the intervention of choice in patients with GERD. Preoperative pH-manometry may identify patients with silent GERD, to candidate them to LGB rather than LSG. pH-manometry should be used more liberally to establish the correct surgical indication on objective grounds.