Laparoscopic Sleeve Gastrectomy: Endoscopic Findings and Gastroesophageal Reflux Symptoms at 18-Month Follow-Up

J Laparoendosc Adv Surg Tech A. 2018 Jan;28(1):71-77. doi: 10.1089/lap.2017.0398. Epub 2017 Dec 11.

Abstract

Introduction: Laparoscopic sleeve gastrectomy (LSG) has shown excellent results in terms of weight loss and resolution of comorbidities. Despite that, the effect of LSG on gastroesophageal reflux disease (GERD) is still a controversial topic. Our objective was to evaluate the presence of gastroesophageal reflux symptoms, erosive esophagitis (EE), and hiatal hernia (HH) in obese patients undergoing LSG.

Methods: Prospective observational study. LSG patients were studied before and at 18-month follow-up. Demographics, anthropometrics, status of comorbidities, perioperative data, GERD symptoms, and esophagogastroduodenoscopy (EGD) findings were evaluated.

Results: Between June 2012 and July 2014, 285 patients underwent LSG. Pre- and postoperative data were available in 109 patients; therefore, they were included in the study. There were 72 women (66%), age 40 ± 9 years. Preoperative body mass index (BMI) was 47.8 ± 16 kg/m2. At 18-month follow-up, body mass index and percentage excess weight loss were 29.3 ± 6 kg/m2 and 64% ± 9.4%, respectively. Resolution/improvement of comorbidities was as follows: diabetes 73%, hypertension 57.5%, and obstructive sleep apnea 89%. GERD symptoms increased from 33% to 44% (P = no statistical significance), EE from 20.1% (100% grade A) to 33.9% (74% grade A) (P < .001), and HH from 22% to 34.8% (P < .001). Postoperative findings on symptomatic patients were as follows: EE was found in 64.5%, HH in 23%, while 12.5% had normal EGD. There was a significant association between manifestation of GERD symptoms and the presence of EE on EGD (P < .05). Symptoms de novo were observed in 36.9% of patients, EE in 28.7%, and HH in 16.4%. Complication rate was 3.5%; there was no mortality.

Conclusion: The prevalence of GERD symptoms, EE, and HH was increased after LSG. At 18-month follow-up, severity of esophagitis was mild, the majority of them being Grade A esophagitis. There was good correlation between manifestation of GERD symptoms and the presence of EE on EGD.

Keywords: endoscopy; reflux; sleeve; sleeve gastrectomy; symptoms.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Body Mass Index
  • Comorbidity
  • Diabetes Mellitus / epidemiology
  • Endoscopy, Gastrointestinal
  • Esophagitis / epidemiology*
  • Female
  • Follow-Up Studies
  • Gastrectomy / adverse effects
  • Gastrectomy / methods*
  • Gastroesophageal Reflux / epidemiology*
  • Hernia, Hiatal / epidemiology*
  • Hernia, Hiatal / surgery
  • Humans
  • Hypertension / epidemiology
  • Laparoscopy / adverse effects
  • Laparoscopy / methods*
  • Male
  • Middle Aged
  • Obesity, Morbid / epidemiology*
  • Obesity, Morbid / surgery*
  • Postoperative Period
  • Prevalence
  • Prospective Studies
  • Sleep Apnea, Obstructive / epidemiology
  • Weight Loss