Post sleeve gastrectomy gastroesophageal reflux- A fact or a fiction

There has been a steady rise in morbid obesity worldwide, which is now commonly referred to as an epidemic. Morbid obesity is linked to multiple adverse health effects, including morbidity and mortality from heart disease, sleep apnea, diabetes mellitus, hypertension, and osteoarthritis.

Bariatric surgery has emerged as the only effective and proven treatment of morbid obesity and obesity-linked complications in the past decade or two. Apart from the most widely used and accepted bariatric surgery, i.e., Roux-en-Y gastric bypass (GB), laparoscopic sleeve gastrectomy (LSG) has also gained popularity in the recent decade.

Giovanni Tomasicchio conducted the study Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy, and colleagues to investigate the occurrence of gastroesophageal reflux disease following laparoscopic sleeve gastrectomy and the analysis of patient's quality of life, weight loss, and comorbidities after surgery.

For this purpose, the researchers retrospectively reviewed the clinical records of 52 patients who submitted for laparoscopic sleeve gastrectomy during January and November 2018 and followed up for three years. The patients underwent screening endoscopy at the end of the follow-up period, and patients with postoperative esophagitis were submitted to pH-impedance monitoring (MII-pH) and endoscopic biopsies. The modified clinical DeMesteer score questionnaire was used to assess the presence of gastroesophageal reflux disease symptoms. The 36-Item Short Form Health Survey and the Bariatric Analysis and Reporting Outcome System score estimated postoperative quality of life.

The researchers reported the following findings:

• During the preoperative work-up, only 7.6% of patients had signs of esophagitis at esophagogastroduodenoscopy, while at a 3-year follow-up, 50% of them showed endoscopic symptoms of GERD.
• Twenty-one of 26 patients with esophagitis signs consented to go through MII-pH.
• The median DeMesteer score questionnaire was 4.5, with only 19% of patients showing a value greater than the pH cut-off value (14.72), which indicates GERD.
• MII-pH data analysis demonstrated gastroesophageal reflux disease presence in five patients.
• In 50% of patients, an excellent outcome on the Bariatric Analysis and Reporting Outcome System score was reported, and all eight domains from the 36-Item Short Form Health Survey improved significantly.

The researchers conclude, "the findings showed an improvement in the quality of life of these patients and the limited refluxogenic nature of laparoscopic sleeve gastrectomy at 3-year follow-up when the basis of diagnosis of gastroesophageal reflux disease was the Lyon consensus."

Reference:

Tomasicchio G, D'abramo FS, Dibra R, Trigiante G, Picciariello A, Dezi A, Rotelli MT, Ranaldo N, Di Leo A, Martines G. Gastroesophageal reflux after sleeve gastrectomy. Fact or fiction? Surgery. 2022 Sep;172(3):807-812. DOI: 10.1016/j.surg.2022.04.040. Epub 2022 Jul 2. PMID: 35791977.